Provider Demographics
NPI:1306632021
Name:TUCKER, MEKKA JAMELIA (RN, BSN)
Entity type:Individual
Prefix:
First Name:MEKKA
Middle Name:JAMELIA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 LAMBRUSCO PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9282
Mailing Address - Country:US
Mailing Address - Phone:910-987-0532
Mailing Address - Fax:
Practice Address - Street 1:588 EXECUTIVE PL STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5187
Practice Address - Country:US
Practice Address - Phone:910-491-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343424163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator