Provider Demographics
NPI:1346629755
Name:TUCKER, KEVIN ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 TABLE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3578
Mailing Address - Country:US
Mailing Address - Phone:530-538-7705
Mailing Address - Fax:
Practice Address - Street 1:82 TABLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3578
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:530-538-7852
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11137175-12042084P0800X
CA172342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry