Provider Demographics
NPI:1215775622
Name:TUCKER, KATHERINE DENISE (CRNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DENISE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DENISE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:5000 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2620
Mailing Address - Country:US
Mailing Address - Phone:267-819-1500
Mailing Address - Fax:
Practice Address - Street 1:5000 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2620
Practice Address - Country:US
Practice Address - Phone:267-819-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner