Provider Demographics
NPI:1154558617
Name:TUCKER, ANDREA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:BLDG B, STE 255
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7676
Mailing Address - Country:US
Mailing Address - Phone:859-744-2623
Mailing Address - Fax:859-744-9421
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:BLDG B, STE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7676
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46054207V00000X
KYR2080207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY46054OtherMEDICAL LICENSE
KY7100253360Medicaid
KYFT2115649OtherDEA
KYR2080OtherSTATE MEDICAL LISCENCE