Provider Demographics
NPI:1467404418
Name:STUCKEY, TRISHA A (FNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:A
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:A
Other - Last Name:GOODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:900 TUTOR LN
Mailing Address - Street 2:STE 102
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7295
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:812-477-7240
Practice Address - Street 1:1101 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8016
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:812-422-2421
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002093A363LF0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300004557Medicaid
INQ71277Medicare UPIN
INP00338502Medicare PIN