Provider Demographics
NPI:1023432952
Name:TUCKER, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ASHLEY
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4845 S SHERIDAN RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5751
Mailing Address - Country:US
Mailing Address - Phone:918-384-0002
Mailing Address - Fax:918-384-0004
Practice Address - Street 1:4845 S SHERIDAN RD
Practice Address - Street 2:SUITE 510
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5751
Practice Address - Country:US
Practice Address - Phone:918-384-0002
Practice Address - Fax:918-384-0004
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK307316171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator