Healthcare Provider Details

I. General information

NPI: 1306303284
Provider Name (Legal Business Name): ALEX RICHARD KUTA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 VALLEY RD STE 200
LINCOLN NE
68510-4882
US

IV. Provider business mailing address

8605 DUNROVIN RD
LINCOLN NE
68526-6068
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4571
  • Fax:
Mailing address:
  • Phone: 402-276-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2369
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: