Provider Demographics
NPI:1699970368
Name:KUCERA, KRISTINE JANE (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:JANE
Last Name:KUCERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2736 WAGONWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4756
Mailing Address - Country:US
Mailing Address - Phone:972-955-8855
Mailing Address - Fax:
Practice Address - Street 1:3041 WASHINGTON DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-1004
Practice Address - Country:US
Practice Address - Phone:469-581-0599
Practice Address - Fax:469-581-0598
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12712Medicare PIN