Provider Demographics
NPI:1760376669
Name:TUCKER, WILMA
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
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 1:403 LICK LOG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:DUNLOW
Mailing Address - State:WV
Mailing Address - Zip Code:25511-8105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:403 LICK LOG BRANCH RD
Practice Address - Street 2:
Practice Address - City:DUNLOW
Practice Address - State:WV
Practice Address - Zip Code:25511-8105
Practice Address - Country:US
Practice Address - Phone:681-219-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide