Provider Demographics
NPI:1578720868
Name:TUCKER, NANCY P (AUD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:P
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HALTON VILLAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREENWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6825
Mailing Address - Country:US
Mailing Address - Phone:864-281-9440
Mailing Address - Fax:864-281-9443
Practice Address - Street 1:115 HALTON VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:GREENWAY
Practice Address - State:SC
Practice Address - Zip Code:29607-6825
Practice Address - Country:US
Practice Address - Phone:864-281-9440
Practice Address - Fax:864-281-9443
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3171231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7844OtherMEDICARE
SCGP4505Medicaid
SCSA0369Medicaid
SCGP4505Medicaid