Provider Demographics
NPI:1588175392
Name:KUKUCKA, AMY M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:KUKUCKA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CANDLEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2227
Mailing Address - Country:US
Mailing Address - Phone:614-312-9412
Mailing Address - Fax:
Practice Address - Street 1:1100 SUNBURY RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-6040
Practice Address - Country:US
Practice Address - Phone:740-417-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner