Provider Demographics
NPI:1386021665
Name:KUCHTA, KELLY (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KUCHTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2152 HAVENWOOD TRL NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4018
Mailing Address - Country:US
Mailing Address - Phone:770-851-1419
Mailing Address - Fax:404-686-4661
Practice Address - Street 1:531 ASBURY CIR
Practice Address - Street 2:SUITE N340
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1006
Practice Address - Country:US
Practice Address - Phone:404-778-5975
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN198383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily