DR. JACK RONALD TACKER (NPI# 1336379403) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1336379403 |
Entity Type | Individual |
Full Name | DR. JACK RONALD TACKER |
Credential | M.D. |
Practice Address |
19160 Front St Ne Poulsbo WA 98370 |
Mailing Address |
Po Box 127 Poulsbo WA 98370-0127 |
Practice Telephone | 3607797500 |
Practice Fax Number | 3606260600 |
Mailing Telephone | 3607797500 |
Mailing Fax Number | 2532882203 |
Enumeration Date | 2009-07-22 |
Last Update Date | 2013-06-05 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208D00000X | General Practice | MD00028053 | WA | Allopathic & Osteopathic Physicians |
Street Address |
19160 FRONT ST NE |
City | POULSBO |
State | WA |
Zip Code | 98370 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710988753 | Martha and Mary Health Services | Skilled Nursing Facility | 19160 Front St Ne, Poulsbo, WA 98370-0127 | 2005-08-01 |
1609351139 | Brittany Leeann Hedin | Occupational Therapy Assistant | 19160 Front St Ne, Poulsbo, WA 98370 | 2018-10-01 |
1699269381 | Alicia Amy Williams | Physical Therapy Assistant | 19160 Front St Ne, Poulsbo, WA 98370 | 2018-06-18 |
1215461025 | Lisa Patureau | Occupational Therapy Assistant | 19160 Front St Ne, Poulsbo, WA 98370 | 2017-04-18 |
1871869313 | Alaire Call Lowe | Speech-Language Pathologist | 19160 Front St Ne, Poulsbo, WA 98370 | 2012-03-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790324010 | Francie Corinn Edens | Massage Therapist | 225 Nw Lindvig Way Suite# 6, Poulsbo, WA 98370 | 2020-01-03 |
1972155679 | Marcela Serocki | Massage Therapist | 18657 Wa-305, Suite 4, Poulsbo, WA 98370 | 2019-07-12 |
1508425943 | Ryan Brinton | Physical Therapist | Kitsap Physical Therapy and Sports Clinics, 19319 7th Ave Ne Ste 108, Poulsbo, WA 98370 | 2019-06-10 |
1598220816 | Naomi Whitney Orong | Massage Therapist | 19068 Nw Jenson Way, Suite 4b, Poulsbo, WA 98370 | 2019-02-01 |
1043774953 | Maryanne Phillips Bellman | Physical Therapist | 442 Viewmont Ave, Poulsbo, WA 98370 | 2019-01-24 |
1285102293 | Andrea Sander | Registered Nurse | 19883 12th Ave Ne, Poulsbo, WA 98370 | 2018-11-07 |
1376038281 | Sharon Renay Christor | Nurse Practitioner | 19160 Front St. Ne, Poulsbo, WA 98370 | 2018-06-25 |
1700304334 | Samantha Przybylek Gavinski | Nurse Practitioner | 19500 10th Ave Ne Suite 100, Poulsbo, WA 98370 | 2017-09-04 |
1285164327 | Johanna Taylor | Behavior Technician | 21786 Windmill Loop Nw, Poulsbo, WA 98370 | 2017-06-12 |
1568990554 | Eva Geurtsen | Physical Therapy Assistant | 19160 Front St, Poulsbo, WA 98370 | 2017-06-02 |
Find all providers in zip 98370 |
Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902017510 | Ruth Urand | General Practice | 278 Ne Moe St, Poulsbo, WA 98370-7347 | 2007-05-25 |
1922030444 | Heritage Health Center Inc | General Practice | 20696 Bond Rd Ne, Suite 110, Poulsbo, WA 98370 | 2006-07-07 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063971703 | Source Northwest Integrative Medicine | General Practice | 7206 267th St Nw Ste 102, Stanwood, WA 98292-6269 | 2019-03-12 |
1255896601 | Emily Christine Buck | General Practice | 940 Fitzsimmons Dr, Tacoma, WA 98431-0001 | 2019-02-08 |
1740755651 | Alyssa Ann Yruegas | General Practice | 2108 W Spruce St, Moses Lake, WA 98837-2853 | 2018-10-06 |
1306321237 | Rainier Springs Physician Group, LLC | General Practice | 2805 Ne 129th Street, Vancouver, WA 98686 | 2018-09-26 |
1962916437 | Parkview Medical Group Inc | General Practice | 615 S Division St Ste A, Moses Lake, WA 98837-3800 | 2017-11-20 |
1790212496 | Thien Thanh Ho | General Practice | 12307 Douglas Rd, Yakima, WA 98908-9129 | 2017-05-12 |
1285173625 | Regenerative Medicine Institute, Pllc | General Practice | 731 N Stanley St, Medical Lake, WA 99022-8940 | 2017-02-17 |
1457708430 | James Bailey | General Practice | 9040 Jackson Ave Tripler Army Medical Center, Tacoma, WA 98431-5001 | 2016-05-19 |
1740635887 | Peter Chulhi Kang | General Practice | 1425 Spring St Apt 802, Seattle, WA 98104-1635 | 2016-04-26 |
1831551084 | Anna Hackenmiller | General Practice | 1657 S Nettleton Ln, Spokane, WA 99224-6108 | 2016-03-27 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.