Healthcare Provider Details

I. General information

NPI: 1053813964
Provider Name (Legal Business Name): JACKIE L KUCHTA DNP FNP-C BC-ADM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S 84TH ST
LA VISTA NE
68128-2127
US

IV. Provider business mailing address

2800 FLATWATER DR APT 203
SOUTH SIOUX CITY NE
68776-5484
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 712-635-8685
  • Fax: 402-944-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA145171
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112433
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: