Active NPI
Bradley David Tuckett, PA-C
- Physician Assistant
- Elk Ridge, UT
National Provider Identifier
1790308260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 8818148-1206
- Practice address
- 245 E Hudson Dr
Elk Ridge, UT 84651-9506 - Phone
- (801) 669-4297
- NPI assigned
- May 19, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 8818148-1206 | UT | Primary |
Addresses
Primary practice location
245 E Hudson Dr
Elk Ridge, UT 84651-9506
Mailing address
4403 Harrison Blvd Ste 4400
Ogden, UT 84403-3290
Phone (801) 387-4550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8818148-1206 | UT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1790308260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4403 HARRISON BLVD STE 4400",
"city": "OGDEN",
"state": "UT",
"postal_code": "844033290",
"telephone_number": "801-387-4550",
"fax_number": "801-387-4565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 E HUDSON DR",
"city": "ELK RIDGE",
"state": "UT",
"postal_code": "846519506",
"telephone_number": "801-669-4297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKETT",
"first_name": "BRADLEY",
"middle_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-05-19",
"last_updated": "2022-12-06",
"certification_date": "2022-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "8818148-1206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Ridge, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.