Provider Demographics
NPI:1528193588
Name:TUCKER, KENYA (PA)
Entity Type:Individual
Prefix:MS
First Name:KENYA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:42 CARRIAGE OAKS DR # 111
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1684
Mailing Address - Country:US
Mailing Address - Phone:404-314-5248
Mailing Address - Fax:770-731-1098
Practice Address - Street 1:6524 OLD NATIONAL HWY STE 203
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-4853
Practice Address - Country:US
Practice Address - Phone:770-731-1098
Practice Address - Fax:404-296-1850
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant