Healthcare Provider Details

I. General information

NPI: 1609764919
Provider Name (Legal Business Name): MELINDA KAY KUCHTA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 DAVID AVE
GRAND ISLAND NE
68803-1113
US

IV. Provider business mailing address

4057 DAVID AVE
GRAND ISLAND NE
68803-1113
US

V. Phone/Fax

Practice location:
  • Phone: 308-395-8002
  • Fax:
Mailing address:
  • Phone: 308-395-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: