MEDICARE: KORA ANN JUCKEM NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95010535	CA

General Provider Information

NPI Number	:	1356882286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORA ANN JUCKEM NP

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	855-501-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 VILLA LA JOLLA DR STE C217
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1712
Country	:	US
Telephone Number	:	855-501-1004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2017
Last Update Date	:	06/04/2026

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