Provider Demographics
NPI:1730401647
Name:TUCKER, MEGAN NICOLE (PMHNP-BC; MSN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PMHNP-BC; MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CROSSRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-8377
Mailing Address - Country:US
Mailing Address - Phone:270-784-9464
Mailing Address - Fax:
Practice Address - Street 1:165 CROSSRIDGE LN
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-8377
Practice Address - Country:US
Practice Address - Phone:270-784-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1140618163W00000X
KYKY-3478225700000X
KY4010680363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist