Provider Demographics
NPI:1306678834
Name:TUCKER, WHITNEY A (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16755 N 350 RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON
Mailing Address - State:OK
Mailing Address - Zip Code:74422-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:OK
Practice Address - Zip Code:74445-4816
Practice Address - Country:US
Practice Address - Phone:918-733-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer