Timothy Pryor Luckett, REGISTERED NURSE

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

RN290090 Issued in CA

Practice address

14171 Shepherd Dr
Rancho Cucamonga, CA 91739-2215

Phone

(909) 268-2126

Fax

(909) 899-8850

NPI assigned

Oct 10, 2007

Last updated

Oct 10, 2007By the provider in NPPES

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": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1629266028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14171 SHEPHERD DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392215",
            "telephone_number": "909-268-2126",
            "fax_number": "909-899-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14171 SHEPHERD DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917392215",
            "telephone_number": "909-268-2126",
            "fax_number": "909-899-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKETT",
        "first_name": "TIMOTHY",
        "middle_name": "PRYOR",
        "name_prefix": "Mr.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "CA",
            "license": "RN290090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Yesenia Lucio
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• Clare Andrea Lueras, NP
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• Maria Elisa Pineda Lugue, PTA
• Luis Alfredo Velazquez, D.D.S. Inc.

• Registered Nurse First Assistant in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Registered Nurse First Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.