Provider Demographics
NPI:1346746799
Name:KUKIELSKI, MEGAN (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KUKIELSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 PALMDALE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7318
Mailing Address - Country:US
Mailing Address - Phone:214-457-4288
Mailing Address - Fax:
Practice Address - Street 1:3801 WILLIAM D TATE AVE STE 800A
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8755
Practice Address - Country:US
Practice Address - Phone:817-612-4499
Practice Address - Fax:855-295-2686
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA119382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty