Provider Demographics
NPI:1417937657
Name:TUCKER, VERNON O (CRNA)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:O
Last Name:TUCKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0583
Mailing Address - Country:US
Mailing Address - Phone:888-991-1101
Mailing Address - Fax:903-787-5854
Practice Address - Street 1:3728 S PINNACLE HILLS PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8897
Practice Address - Country:US
Practice Address - Phone:479-790-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC000969367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917321903Medicaid
AR5T077OtherBCBS
AR134260701Medicaid
AR134260701Medicaid
MO917321903Medicaid