Provider Demographics
NPI:1669006995
Name:TUCKER, VAKESHA
Entity Type:Individual
Prefix:MS
First Name:VAKESHA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VAKESHA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KESHA
Mailing Address - Street 1:4591 MICHIGAN BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1226
Mailing Address - Country:US
Mailing Address - Phone:330-507-4467
Mailing Address - Fax:
Practice Address - Street 1:4591 MICHIGAN BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1226
Practice Address - Country:US
Practice Address - Phone:330-507-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide