Active NPI
Nicole Renee Tucker
- Physical Therapy Assistant
- Decatur, IL
National Provider Identifier
1194089359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160005008
- Practice address
- 2300 N Edward St
Decatur, IL 62526-4163 - Phone
- (217) 876-2600
- Fax
- (217) 876-2615
- NPI assigned
- Jul 2, 2012
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160005008 | IL | Primary |
Addresses
Primary practice location
2300 N Edward St
Decatur, IL 62526-4163
Mailing address
2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-2600
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 |
|---|---|---|---|
| 160005008 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341187200000",
"number": "1194089359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 N EDWARD ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625264163",
"telephone_number": "217-876-2600",
"fax_number": "217-876-2615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N EDWARD ST",
"city": "DECATUR",
"state": "IL",
"postal_code": "625264163",
"telephone_number": "217-876-2600",
"fax_number": "217-876-2615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "NICOLE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-02",
"last_updated": "2012-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160005008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.