Provider Demographics
NPI:1619563608
Name:TUCKER, CRYSTAL FELITA (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:FELITA
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 1:35 VILLAGE GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2931
Mailing Address - Country:US
Mailing Address - Phone:901-258-6565
Mailing Address - Fax:
Practice Address - Street 1:35 VILLAGE GREEN CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2931
Practice Address - Country:US
Practice Address - Phone:601-573-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS888920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse