Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KYLE DAVID TUCKER RN
NPI 1104706365
Nurse Practitioner in Thousand Oaks, CA

Q: What is Kyle Tucker's NPI number?

The NPI number for Kyle Tucker is 1104706365. It was assigned to this individual provider in the NPPES registry on September 6, 2025.

Q: What is Kyle Tucker's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kyle Tucker was last updated on August 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 29 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 06, 2025PECOS Enrolled

215 W JANSS RD, THOUSAND OAKS, CA 91360(805) 370-4436 Get Directions Write a Review

NPPES record last updated: August 13, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Aug 13, 2026, Sep 6, 2025 (2 updates tracked since 2025).

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About Kyle David Tucker Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYLE DAVID TUCKER RN (NPI 1104706365) is an individual nurse practitioner in Thousand Oaks, California, licensed in California (95039691) and active in the NPI registry since September 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104706365

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameKYLE DAVID TUCKERCredential: RN

Location Address215 W JANSS RDThousand Oaks, CA 91360-1847

Mailing Address840 Moffatt CirSimi Valley, CA 93065-5633

Phone(805) 370-4436

Sole ProprietorYes

Enumeration DateSeptember 6, 2025

Last NPPES UpdateAugust 13, 20262 updates tracked since enumeration

NPPES CertifiedAugust 13, 2026

✔ NPI 1104706365 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in CA · 95039691

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedRegistered Nurse · EmergencyTaxonomy 163WE0003X · License 95255871 (CA)

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 95039691 (CA)

215 W JANSS RD, Thousand Oaks, CA 91360

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kyle David Tucker Rn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91360 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$95.28 typical visit price

range $62.32 – $185.36

Typical copayment $23.82 (range $15.58 – $46.34)

Most-billed visit code 99203

Established Patient

$108.74 typical visit price

range $20.68 – $151.85

Typical copayment $27.18 (range $5.17 – $37.96)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LOS ROBLES RADIOLOGIC ASSOCIATES

Radiology (Diagnostic Radiology)