Active NPI
Candy Tucker
- Gerontology Registered Nurse
- Anna, IL
National Provider Identifier
1396408159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Registered Nurse
- License
- 041417537
- Practice address
- 315 Brady Mill Rd
Anna, IL 62906-2306 - Phone
- (618) 833-6343
- NPI assigned
- Oct 19, 2021
- 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 |
|---|---|---|---|---|
| Gerontology Registered Nurse | 163WG0600X | 041417537 | IL | Primary |
Addresses
Primary practice location
315 Brady Mill Rd
Anna, IL 62906-2306
Mailing address
315 Brady Mill Rd
Anna, IL 62906-2306
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | administrator@annarnc.com |
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 |
|---|---|---|---|
| 041417537 | IL | MD | Gerontology Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634601600000",
"number": "1396408159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 BRADY MILL RD",
"city": "ANNA",
"state": "IL",
"postal_code": "629062306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 BRADY MILL RD",
"city": "ANNA",
"state": "IL",
"postal_code": "629062306",
"telephone_number": "618-833-6343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "CANDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-19",
"last_updated": "2021-10-19",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0600X",
"taxonomy_group": "",
"desc": "Registered Nurse, Gerontology",
"state": "IL",
"license": "041417537",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "administrator@annarnc.com",
"affiliation": "N",
"address_1": "315 Brady Mill Rd",
"city": "Anna",
"state": "IL",
"country_code": "US",
"postal_code": "629062306",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Anna, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.