Provider Demographics
NPI:1487804472
Name:TUCKER, VICKI LYNN (LPN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 W COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-8093
Mailing Address - Country:US
Mailing Address - Phone:765-793-0252
Mailing Address - Fax:
Practice Address - Street 1:1600 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1715
Practice Address - Country:US
Practice Address - Phone:765-793-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27061558A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse