Jerry Lan Tucker, RDN

Primary specialty

Oncology Nutrition Registered DietitianTaxonomy code 133VN1301X

License

LD2023084 Issued in NM

Practice address

715 Dr Martin Luther King Jr Ave NE Ste 102
Albuquerque, NM 87102-3666

Phone

(505) 727-3028

NPI assigned

Jun 6, 2023

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

Enrolled in NM

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest Medical Associates, LLCGroup PAC ID 7214831114, 326 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Southwest Medical Associates, LLC

  dba Lovelace Medical Group

  • General Practice Physician
  • Albuquerque, NM
  • NPI 1164491072
  Medicare reassignment Care Compare group NPD
• Southwest Medical Associates, LLC

  • Rural Health Clinic/Center
  • Roswell, NM
  • NPI 1578255253
  NPD
• Fay Nutrition

  • Registered Dietitian
  • San Francisco, CA
  • NPI 1104334465
  NPD (past)
• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824
  NPD (past)

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1952095556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 GOLF COURSE RD NW STE 183",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871205842",
            "telephone_number": "917-334-2823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 DR MARTIN LUTHER KING JR AVE NE STE 102",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023666",
            "telephone_number": "505-727-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JERRY",
        "middle_name": "LAN",
        "name_prefix": "Mr.",
        "credential": "RDN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1301X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Oncology",
            "state": "NM",
            "license": "LD2023084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Tucker
• Allen Jacob Tucker
• Carey M Tucker, PA
• Craig E Tucker, MS- CCC-SLP
• Debra J. Tucker
• Merrill Ralph Tucker III
• Paul Norman Tucker, MS, LADAC
• Shawna Leann Tucker, L.M.T
• Olivia Joyce Tudor, PH.D.
• David Eric Tuggle, DDS

• Registered Dietitian in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Registered Dietitian in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.