Provider Demographics
NPI:1417081126
Name:TUCKER, PATRICIA NICOLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:NICOLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:NICOLE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1017 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6187
Mailing Address - Country:US
Mailing Address - Phone:270-871-7319
Mailing Address - Fax:
Practice Address - Street 1:1017 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6187
Practice Address - Country:US
Practice Address - Phone:270-871-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist