Provider Demographics
NPI:1053813964
Name:KUCHTA, JACKIE L (DNP FNP-C BC-ADM)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:L
Last Name:KUCHTA
Suffix:
Gender:F
Credentials:DNP FNP-C BC-ADM
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Mailing Address - Street 1:2800 FLATWATER DR APT 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-5484
Mailing Address - Country:US
Mailing Address - Phone:712-635-8685
Mailing Address - Fax:402-944-1450
Practice Address - Street 1:100 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-3023
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-5381
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2024-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAA145171363LF0000X
NE112433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily