Healthcare Provider Details

I. General information

NPI: 1801830674
Provider Name (Legal Business Name): RITA A KUCMIERZ WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 W OAK ST
PALESTINE TX
75801-8484
US

IV. Provider business mailing address

PO BOX 145
PALESTINE TX
75802-0145
US

V. Phone/Fax

Practice location:
  • Phone: 903-731-7000
  • Fax: 903-731-7016
Mailing address:
  • Phone: 903-731-7000
  • Fax: 903-731-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberKUCI-0432-0113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: