Provider Demographics
NPI:1932963410
Name:RUCKER, KRISTEN ELLEN
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELLEN
Last Name:RUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:ELLEN
Other - Last Name:DUNAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4048 LUKE CT STE C
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1034
Mailing Address - Country:US
Mailing Address - Phone:615-625-6114
Mailing Address - Fax:
Practice Address - Street 1:4048 LUKE CT STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-1034
Practice Address - Country:US
Practice Address - Phone:615-625-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program