Provider Demographics
NPI:1902190671
Name:TUCKER, LAUREN WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:WILLIAMS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:HALEY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304B CHARLES T WETHINGTON BLDG
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-9918
Mailing Address - Fax:859-323-1197
Practice Address - Street 1:304B CHARLES T WETHINGTON BLDG
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0200
Practice Address - Country:US
Practice Address - Phone:859-323-9918
Practice Address - Fax:859-323-1197
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2659207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program