Provider Demographics
NPI:1659678399
Name:TUCK, RAE LYNNE (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:LYNNE
Last Name:TUCK
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 KANIS RD
Mailing Address - Street 2:700
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3727
Mailing Address - Country:US
Mailing Address - Phone:501-312-0070
Mailing Address - Fax:501-312-0072
Practice Address - Street 1:11600 KANIS RD
Practice Address - Street 2:700
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3727
Practice Address - Country:US
Practice Address - Phone:501-312-0070
Practice Address - Fax:501-312-0072
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS01052364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health