Healthcare Provider Details

I. General information

NPI: 1043725997
Provider Name (Legal Business Name): JENNIFER M. KUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

5567 SEAPINE RD
HILLIARD OH
43026-8285
US

V. Phone/Fax

Practice location:
  • Phone: 614-944-5123
  • Fax:
Mailing address:
  • Phone: 614-205-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number6266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: