Healthcare Provider Details

I. General information

NPI: 1508635764
Provider Name (Legal Business Name): MEGAN M KUCERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 14TH ST STE 9
HASTINGS NE
68901-3240
US

IV. Provider business mailing address

223 E 14TH ST STE 9
HASTINGS NE
68901-3240
US

V. Phone/Fax

Practice location:
  • Phone: 402-834-0884
  • Fax: 888-972-3670
Mailing address:
  • Phone: 402-834-0884
  • Fax: 888-972-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13735
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: