Provider Demographics
NPI:1184253791
Name:TUCKER, KENDRA (RN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 ARBOR BND APT 812
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2919
Mailing Address - Country:US
Mailing Address - Phone:682-597-4500
Mailing Address - Fax:
Practice Address - Street 1:6033 ARBOR BND APT 812
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2919
Practice Address - Country:US
Practice Address - Phone:682-597-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse