NPIMap

Individual provider Active NPI

Stephanie Tucker, M.D.

  • Psychiatry Physician
  • Fort Collins, CO
National Provider Identifier
1417137977
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
DR.0072096 Issued in CO
Practice address
4601 Corbett Dr
Fort Collins, CO 80528-9579
Phone
(970) 207-4857
Fax
(970) 207-4885
NPI assigned
Nov 13, 2007
Last updated
Jan 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X D0064887 MD
Psychiatry Physician 2084P0800X 13209A WY
Psychiatry Physician 2084P0800X DR.0072096 CO Primary

Addresses

Primary practice location

4601 Corbett Dr
Fort Collins, CO 80528-9579

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (706) 242-4219

Other practice location 1

2600 E 18th St
Cheyenne, WY 82001-5511
Phone (307) 633-7370

Other identifiers 2

IdentifierTypeStateIssuer
18528830MedicaidNM
81780052MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240416001460 CO Practitioner - Psychiatry 8224212253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

4601 S Mason St
Fort Collins, CO 80525-3740
Phone (970) 266-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13209AWYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Health Care Inc. CurrentSince Feb 26, 2024 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 29, 2025 Accepting new patients
Poudre Valley Health Care Inc. Current Accepting new patients
Poudre Valley Health Care Inc CurrentSince Feb 26, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Poudre Valley Health Care,Inc Past Accepting new patients

Locations

1025 Pennock Pl
Fort Collins, CO 80524
Phone (970) 495-8800

1107 S Lemay Ave
Ste 100
Fort Collins, CO 80524
Phone (970) 207-4857

4601 Corbett Dr
Fort Collins, CO 80528
Phone (970) 207-4800

4601 S Mason St
Fort Collins, CO 80525
Phone (970) 266-3600

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Interoperability endpoints

  • Direct secure messaging: stucker43641@direct.crmcwy.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1417137977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "706-242-4219",
            "fax_number": "704-904-1569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 CORBETT DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805289579",
            "telephone_number": "970-207-4857",
            "fax_number": "970-207-4885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 E 18th St",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820015511",
            "country_code": "US",
            "telephone_number": "307-633-7370",
            "fax_number": "307-633-7202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-13",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0064887",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WY",
            "license": "13209A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "DR.0072096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18528830",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81780052",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.