MEDICARE: MS. RITA A KUCMIERZ WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	KUCI-0432-0113	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KUCI-0432-0113	OTHER	TX	NP LICENSE

General Provider Information

NPI Number	:	1801830674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA A KUCMIERZ WHNP

Provider Business Mailing Address
First Line	:	PO BOX 145
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75802-0145
Country	:	US
Telephone Number	:	903-731-7000
Fax Number	:	903-731-7016

Provider Business Practice Location Address
First Line	:	3215 W OAK ST
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-8484
Country	:	US
Telephone Number	:	903-731-7000
Fax Number	:	903-731-7016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/21/2015

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