Provider Demographics
NPI:1669453882
Name:TUCKER, JOHN WILLIAM (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-1309
Mailing Address - Country:US
Mailing Address - Phone:828-389-6383
Mailing Address - Fax:828-389-2322
Practice Address - Street 1:241 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-9688
Practice Address - Country:US
Practice Address - Phone:828-389-6383
Practice Address - Fax:828-389-2322
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752879BMedicare ID - Type UnspecifiedMEDICARE
NCP10065Medicare UPIN