Provider Demographics
NPI:1811331424
Name:TUCKER, KAREN SOUZA (RN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SOUZA
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 1:995 NANTAHALA DR
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-8653
Mailing Address - Country:US
Mailing Address - Phone:864-706-6911
Mailing Address - Fax:
Practice Address - Street 1:2055 HANGING ROCK RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7407
Practice Address - Country:US
Practice Address - Phone:864-578-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51376163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool