Provider Demographics
NPI:1215266556
Name:TUCKER, EMILY A (FNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4708
Mailing Address - Country:US
Mailing Address - Phone:662-841-9096
Mailing Address - Fax:
Practice Address - Street 1:532 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4708
Practice Address - Country:US
Practice Address - Phone:662-841-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily