Jonathan Tucker, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT5626 Issued in TX

Practice address

1801 S Stewart St
Azle, TX 76020-3068

Phone

(817) 253-5820

NPI assigned

Jul 23, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417470337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7083 BRIAR RD",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760207033",
            "telephone_number": "817-253-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 S STEWART ST",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760203068",
            "telephone_number": "817-253-5820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7083 Briar Road",
            "address_purpose": "LOCATION",
            "city": "Azle",
            "state": "TX",
            "postal_code": "76020",
            "country_code": "US",
            "telephone_number": "817-253-5820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT5626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Azle, TX
• Providers in Azle, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.