Kevin Eugene Puckett Jr.

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

5425 Sierra Vista Ave
Riverside, CA 92505-3113

Phone

(951) 299-7645

NPI assigned

May 18, 2022

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1619614807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 LA SIERRA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035271",
            "telephone_number": "951-299-7645",
            "fax_number": "951-299-7510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5425 SIERRA VISTA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053113",
            "telephone_number": "951-299-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "KEVIN",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Manager/Care Coordinator in Riverside, CA
• Providers in Riverside, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.