Provider Demographics
NPI:1962183749
Name:TUCKER, JOSHUA LEE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PARKERS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4152
Mailing Address - Country:US
Mailing Address - Phone:606-485-4003
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-485-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1202659175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist