Provider Demographics
NPI:1407585177
Name:TUCKER, MEGAN J
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:J
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6232
Mailing Address - Country:US
Mailing Address - Phone:405-464-6060
Mailing Address - Fax:
Practice Address - Street 1:115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-9622
Practice Address - Country:US
Practice Address - Phone:405-872-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator