Provider Demographics
NPI:1386805422
Name:TUCKER, CARRIE DAWN
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DAWN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CANTERBURY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1266
Mailing Address - Country:US
Mailing Address - Phone:502-839-1871
Mailing Address - Fax:
Practice Address - Street 1:121 CANTERBURY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1266
Practice Address - Country:US
Practice Address - Phone:502-839-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker