Active NPI
Jessica Puckett
- Pharmacist
- Dyersburg, TN
National Provider Identifier
1124525308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 29359
- Practice address
- 2650 Lake Rd
Dyersburg, TN 38024-1656 - Phone
- (731) 286-6700
- NPI assigned
- Apr 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 29359 | TN | Primary |
Addresses
Primary practice location
2650 Lake Rd
Dyersburg, TN 38024-1656
Mailing address
2650 Lake Rd
Dyersburg, TN 38024-1656
Phone (731) 286-6700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29359 | TN | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523491200000",
"number": "1124525308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 LAKE RD",
"city": "DYERSBURG",
"state": "TN",
"postal_code": "380241656",
"telephone_number": "731-286-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 LAKE RD",
"city": "DYERSBURG",
"state": "TN",
"postal_code": "380241656",
"telephone_number": "731-286-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-12",
"last_updated": "2018-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "29359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyersburg, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.