Ke'Ara Denae Tucker, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126003552 Issued in VA

Practice address

400 S Mesa Dr
Hopewell, VA 23860-4138

Phone

(434) 210-0755

NPI assigned

Aug 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654387200000",
    "number": "1104472869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 FINNEYWOOD RD",
            "city": "CHASE CITY",
            "state": "VA",
            "postal_code": "239242606",
            "telephone_number": "434-210-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S MESA DR",
            "city": "HOPEWELL",
            "state": "VA",
            "postal_code": "238604138",
            "telephone_number": "434-210-0755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "402 E College St",
            "address_purpose": "LOCATION",
            "city": "Bridgewater",
            "state": "VA",
            "postal_code": "22812",
            "country_code": "US",
            "telephone_number": "540-282-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 E College St",
            "address_purpose": "LOCATION",
            "city": "Bridgewater",
            "state": "VA",
            "postal_code": "22812",
            "country_code": "US",
            "telephone_number": "540-282-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "KE'ARA",
        "middle_name": "DENAE",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-16",
        "last_updated": "2022-06-05",
        "certification_date": "2022-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126003552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Hopewell, VA
• Providers in Hopewell, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.