Provider Demographics
NPI:1215596036
Name:TUCKER, MCKENZIE B (DO)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:B
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:1413 N ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2767
Practice Address - Country:US
Practice Address - Phone:270-827-8662
Practice Address - Fax:270-826-8220
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11020485A207Q00000X
KY05137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine