Provider Demographics
NPI:1396315867
Name:TUCKER, MCKENZIE PAIGE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:PAIGE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 OLD BOONES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4723
Mailing Address - Country:US
Mailing Address - Phone:423-426-6400
Mailing Address - Fax:
Practice Address - Street 1:1305 OLD BOONES CREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-4723
Practice Address - Country:US
Practice Address - Phone:423-426-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer