Provider Demographics
NPI:1881184067
Name:TUCKER, JUDITH LYNN CORRADO (APRN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN CORRADO
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:CORRADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:175 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2268
Mailing Address - Country:US
Mailing Address - Phone:513-240-2985
Mailing Address - Fax:513-938-8180
Practice Address - Street 1:58 CAROTHERS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2416
Practice Address - Country:US
Practice Address - Phone:513-240-2985
Practice Address - Fax:513-938-8180
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012260363L00000X
OHAPRN.CNP.022476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner