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General NPI Number Information
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NPI Number | 1851381644
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Entity Type | Individual
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Provider Name | SHAUN LEIGH KUETER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-956-0392
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Fax | 270-956-0737
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Provider Business Mailing Address
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Address Line | 3650 HIGHWAY 41A S
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6800
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Country | US
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Telephone | 870-378-3726
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Fax |
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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 | APN0000017577
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A03004ANP
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License Number State | AR
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