Peytan Alexa Crapo Tucker, LMSW – Social Worker

Key facts

NPI: 1801636352
Entity type: Individual (NPI type 1)
Primary specialty: Social Worker 104100000X
License: LMSW-45232 (ID)
Practice address: 242 E 7TH N Ste 4
Rexburg, ID 83440-3550
Phone: (208) 359-9683
NPI assigned: May 30, 2024
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
LMSW-45232	ID	MD	Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Social Worker	104100000X	LMSW-45232	ID	Yes

Addresses

Primary practice location

242 E 7TH N Ste 4
Rexburg, ID 83440-3550

Mailing address

242 E 7TH N Ste 4
Rexburg, ID 83440-3550
Phone (208) 359-9683

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 30, 2024.

{
    "created_epoch": "1717027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1801636352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 E 7TH N STE 4",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834403550",
            "telephone_number": "208-359-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 E 7TH N STE 4",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834403550",
            "telephone_number": "208-359-9683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "PEYTAN",
        "middle_name": "ALEXA CRAPO",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-30",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-45232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

All providers in Rexburg, ID · Social Worker in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.