Individual provider Active NPI

Dominique Tucker, RDN

  • Registered Dietitian
  • Chandler, AZ
National Provider Identifier
1487446480
Registry record updated Feb 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
86418236 Issued in AZ
Practice address
3100 W Ray Rd Ste 201
Chandler, AZ 85226-2472
Phone
(623) 399-6825
Fax
(623) 505-3474
NPI assigned
May 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 86418236 AZ Primary

Addresses

Primary practice location

3100 W Ray Rd Ste 201
Chandler, AZ 85226-2472

Mailing address

18001 N 79TH Ave Ste A12
Glendale, AZ 85308-8398
Phone (623) 399-6825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260224004143 AZ Practitioner - Registered Dietitian Or Nutrition Professional 4082195425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

18001 N 79TH Ave
Suite A12
Glendale, AZ 85308-8398

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
86418236AZMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Am Nutrition Services Dietitian, Registered CurrentSince Feb 9, 2026 Accepting new patients

Locations

3100 W Ray Rd
Ste 201
Chandler, AZ 85226
Phone (269) 312-1446

18001 N 79th Ave
Ste A12
Glendale, AZ 85308
Phone (623) 321-5380

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770768000000",
    "number": "1487446480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18001 N 79TH AVE STE A12",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088398",
            "telephone_number": "623-399-6825",
            "fax_number": "623-505-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 W RAY RD STE 201",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262472",
            "telephone_number": "623-399-6825",
            "fax_number": "623-505-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "DOMINIQUE",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-19",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AZ",
            "license": "86418236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.