Provider Demographics
NPI:1750704862
Name:TUCKER, RHONDA RHEA (RDMS,RVT,RCS,RT(R))
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:RHEA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RDMS,RVT,RCS,RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 INTERCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-6011
Mailing Address - Country:US
Mailing Address - Phone:662-862-9040
Mailing Address - Fax:662-862-9091
Practice Address - Street 1:202 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6011
Practice Address - Country:US
Practice Address - Phone:662-862-9040
Practice Address - Fax:662-862-9091
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00062071 CCI246XS1301X
MSMRT0457247100000X
21187 ARDMS2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography