Active NPI
Jesse Raymond Tucker, CRNA
- Certified Registered Nurse Anesthetist
- Dunn, NC
National Provider Identifier
1174625925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 031777
- Practice address
- 800 Tilghman Dr
Dunn, NC 28334-5510 - Phone
- (910) 892-1000
- Fax
- (910) 891-6032
- NPI assigned
- Sep 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 031777 | NC | Primary |
Addresses
Primary practice location
800 Tilghman Dr
Dunn, NC 28334-5510
Mailing address
306 Village Square Dr
Dunn, NC 28334-2850
Phone (910) 892-7664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 062995 | Other | NC | NC BOARD OF NURSING VERIF |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031777 | NC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174625925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 VILLAGE SQUARE DR",
"city": "DUNN",
"state": "NC",
"postal_code": "283342850",
"telephone_number": "910-892-7664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 TILGHMAN DR",
"city": "DUNN",
"state": "NC",
"postal_code": "283345510",
"telephone_number": "910-892-1000",
"fax_number": "910-891-6032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "JESSE",
"middle_name": "RAYMOND",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "031777",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC BOARD OF NURSING VERIF",
"identifier": "062995",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dunn, NC
- Tri County Community Health Council Inc. (CommWell Health -Newton Grove/Spivey's Corner Medical)
- Tricare Counseling & Consulting, Inc. (Tricare Child & Family Counseling)
- Trident Pulmonary & Sleep Medicine, PLLC
- Trinity Rehab LLC
- Trust the Process Inc.
- Melissa Bland Turner, PHARMD
- Kayla Bren Raynor Tyndall, PA
- United Rehabilitation Services, Inc
- Unlimited Access Home Care Agency, Inc.
- Unlimited Access, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.