Individual
MR. THOMAS EDWIN PUCKETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
3834 S EMERSON AVE, BLDG C STE 100, INDIANAPOLIS, IN 46203
(317) 782-1577
(888) 366-7577
Mailing address
PO BOX 3299, CARSON CITY, NV 89702-3299
(775) 222-0044
(888) 700-0187
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005644A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201312180
—
IN
Enumeration date
08/06/2015
Last updated
08/02/2018
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