Provider Demographics
NPI:1619584505
Name:TUCKER, EDWARD AUSTIN (CRNP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:AUSTIN
Last Name:TUCKER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3428
Mailing Address - Country:US
Mailing Address - Phone:205-384-0141
Mailing Address - Fax:205-384-0171
Practice Address - Street 1:20 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3428
Practice Address - Country:US
Practice Address - Phone:205-384-0141
Practice Address - Fax:205-384-0171
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129003363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health