Provider Demographics
NPI:1659505113
Name:TUCKER, SUMMER RAYE (DO)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:RAYE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HOTCHKISS ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1340
Mailing Address - Country:US
Mailing Address - Phone:270-465-0191
Mailing Address - Fax:270-465-0463
Practice Address - Street 1:410 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1340
Practice Address - Country:US
Practice Address - Phone:270-465-0191
Practice Address - Fax:270-465-0463
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005817A207Q00000X
KY03404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008016205OtherSTATE OF MISSOURI LISCENSE
KYKY03404OtherKY BOARD OF MEDICINE