Provider Demographics
NPI:1881368934
Name:TUCKER, BETHANY JEANNINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEANNINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JEANNINE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 MEDICAL ST
Mailing Address - Street 2:
Mailing Address - City:SNEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35952-6468
Mailing Address - Country:US
Mailing Address - Phone:205-386-4341
Mailing Address - Fax:
Practice Address - Street 1:180 MEDICAL ST
Practice Address - Street 2:
Practice Address - City:SNEAD
Practice Address - State:AL
Practice Address - Zip Code:35952-6468
Practice Address - Country:US
Practice Address - Phone:205-386-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily