Jeremy Rucker
Individual provider Active NPI Driver · Walla Walla, WA
NPI 1992494587 · NPPES record last updated May 1, 2023
Key facts
- NPI
- 1992494587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 414 N 7TH Ave
Walla Walla, WA 99362-1717 - Phone
- (541) 809-8622
- NPI assigned
- May 1, 2023
- Sex
- Male
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
414 N 7TH Ave
Walla Walla, WA 99362-1717
Mailing address
414 N 7TH Ave
Walla Walla, WA 99362-1717
Phone (541) 809-8622
Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2023. 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.