Provider Demographics
NPI:1194375758
Name:KUKER, JENNIFER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KUKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:
Other - Last Name:KUKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13201 COUNTY ROAD 261C
Mailing Address - Street 2:
Mailing Address - City:NATHROP
Mailing Address - State:CO
Mailing Address - Zip Code:81236-9788
Mailing Address - Country:US
Mailing Address - Phone:405-301-2129
Mailing Address - Fax:
Practice Address - Street 1:16701 N ORACLE RD STE 135
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9102
Practice Address - Country:US
Practice Address - Phone:520-825-6763
Practice Address - Fax:520-825-6841
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ604996Medicaid