Active NPI
Tara L Puckett, L.P.N.
- Licensed Practical Nurse
- Ashland, OH
National Provider Identifier
1174959274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 154092
- Practice address
- 120 W 10TH St
Ashland, OH 44805-1739 - Phone
- (419) 651-0570
- NPI assigned
- Sep 20, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 154092 | OH | Primary |
Addresses
Primary practice location
120 W 10TH St
Ashland, OH 44805-1739
Mailing address
120 W 10TH St
Ashland, OH 44805-1739
Phone (419) 651-0570
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3018406 | Other | OH | PERSONAL CARE AIDE |
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 |
|---|---|---|---|
| 154092 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379635200000",
"number": "1174959274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 W 10TH ST",
"city": "ASHLAND",
"state": "OH",
"postal_code": "448051739",
"telephone_number": "419-651-0570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 W 10TH ST",
"city": "ASHLAND",
"state": "OH",
"postal_code": "448051739",
"telephone_number": "419-651-0570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "TARA",
"middle_name": "L",
"credential": "L.P.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-20",
"last_updated": "2013-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "154092",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CARE AIDE",
"identifier": "3018406",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.