Provider Demographics
NPI:1528436334
Name:TUCKER, SHONDA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:LYNN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-4400
Mailing Address - Country:US
Mailing Address - Phone:423-784-7272
Mailing Address - Fax:423-784-1136
Practice Address - Street 1:188 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4400
Practice Address - Country:US
Practice Address - Phone:423-784-7272
Practice Address - Fax:423-784-1136
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20385363L00000X
KY3009676363LF0000X
TNAPN0000020385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner