Provider Demographics
NPI:1609565308
Name:TUCKER, SKYLAR A I
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:A I
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SKYE
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2600 VAN BUREN ST STE 2634
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5610
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:
Practice Address - Street 1:1205 MEADOWLAKE DR
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-8331
Practice Address - Country:US
Practice Address - Phone:405-360-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst