Provider Demographics
NPI:1699383414
Name:TUCKER, KERRY A (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-0192
Mailing Address - Country:US
Mailing Address - Phone:304-876-3500
Mailing Address - Fax:304-254-6970
Practice Address - Street 1:4781 KEARNEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4666
Practice Address - Country:US
Practice Address - Phone:304-876-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106714363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health