Provider Demographics
NPI:1861551400
Name:TUCKER, VANESSA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:VANESSA
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 1:4913 MARIAN CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1448
Mailing Address - Country:US
Mailing Address - Phone:859-296-1167
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1113
Practice Address - Country:US
Practice Address - Phone:859-257-1000
Practice Address - Fax:859-323-1194
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1099916163WS0200X
KY3017881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool