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General NPI Number Information
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NPI Number | 1386021665
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Entity Type | Individual
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Provider Name | KELLY KUCHTA N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 531 ASBURY CIR SUITE N340
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City | ATLANTA
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State | GA
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Zip | 30322-1006
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Country | US
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Telephone | 404-778-5975
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Fax | 404-778-2630
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Provider Business Mailing Address
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Address Line | 2152 HAVENWOOD TRL NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-4018
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Country | US
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Telephone | 770-851-1419
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Fax | 404-686-4661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN198383
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License Number State | GA
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