Alec Dalton-Shea Puckett

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1215 S Boulder Ave
Tulsa, OK 74119-2842

Phone

(918) 631-2619

NPI assigned

Aug 25, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• University of Tulsa

  • Student in an Organized Health Care Education/Training Program
  • Tulsa, OK
  • NPI 1225418395
  NPD

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1538836739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13401 S 87TH EAST AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740083443",
            "telephone_number": "918-857-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 S BOULDER AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741192842",
            "telephone_number": "918-631-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "ALEC",
        "middle_name": "DALTON-SHEA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Psychiatric Services, Inc.
• Psychiatry of Tulsa, P.C.
• Psychological Assessment Advocacy and Treatment Center for Children
• Psychological Services of Tulsa, LLC
• Psychotherapy Solutions of Tulsa LLC
• Andrew Dawson Puckett
• Annajo N Puckett, LPC CANDIDATE
• Donna Carole Puckett, MD
• Madison Anne Puckett, DO
• Scott Louis Puckett, MD, PHD

• Student in an Organized Health Care Education/Training Program in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Student in an Organized Health Care Education/Training Program in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.

Verify at the official NPI Registry.