Provider Demographics
NPI:1275063331
Name:KUCINSKI, BERNADETTE (NP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:KUCINSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1406
Mailing Address - Country:US
Mailing Address - Phone:210-704-1888
Mailing Address - Fax:210-333-0775
Practice Address - Street 1:1222 N MAIN AVE STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5780
Practice Address - Country:US
Practice Address - Phone:210-504-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134138363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care