Tucker Lee Brady, FNP
Individual provider Active NPI Family Nurse Practitioner · Brookhaven, MS
NPI 1679107692 · NPPES record last updated Jan 9, 2025
Key facts
- NPI
- 1679107692
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 903771 (MS)
- Practice address
- 601 Brookman Dr Ext
Brookhaven, MS 39601-2371 - Phone
- (601) 823-5275
- NPI assigned
- Feb 28, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- KDMC Physician Clinics LLC
Practice addresses (Care Compare)
601 Brookman Dr Ext a
KDMC Orthopedic Clinic
Brookhaven, MS 39601-2371
Phone (601) 823-5275
Hospital & facility affiliations
- King'S Daughters Medical Center-Brookhaven
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200928001941 | MS | Practitioner - Nurse Practitioner | 4981023751 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kings Daughters Medical Center | Current | Accepting new patients | |
| Fast Pace Mississippi, PLLC | Family | Current |
Accepting new patients |
| King'S Daughters Medical Center | Current |
Accepting new patients | |
| King'S Daughters Medical Center | Current |
Accepting new patients | |
| KDMC Physician Clinics LLC | Current |
Accepting new patients | |
| Fast Pace Mississippi, PLLC | Current |
Accepting new patients |
Locations
601 Brookman Dr Ext
#A
Brookhaven, MS 39601
Phone (601) 823-5275
940 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 823-5000
427 Highway 51 N
Brookhaven, MS 39601
Phone (601) 833-6011
601 Brookman Dr Ext
Brookhaven, MS 39601
Phone (601) 823-5275
950 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 833-7973
602 Craft St
Holly Springs, MS 38635
Phone (662) 333-8070
517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206
Interoperability endpoints
- https://api.platform.athenahealth.com/6393/brand/1/csg/41/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 903771 | MS | Yes |
Addresses
Primary practice location
601 Brookman Dr Ext
Brookhaven, MS 39601-2371
Mailing address
1522 Old Highway 51 NE
Brookhaven, MS 39601-9553
Phone (601) 754-2690
Other practice location 1
427 Highway 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011
Other providers in Brookhaven, MS
- Spencer Lamar Bonds
- Jessica Boutwell
- William Kelly Boutwell
- James Jeffery Boyd
- David Steven Braden
- Yolanda Shay Bridges
- Bridging Community With Healthcare, LLC
- Britt Medical Group LLC
- Blaine Cooper Britt
- Robert B Britt
All providers in Brookhaven, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.