Provider Demographics
NPI:1801830674
Name:KUCMIERZ, RITA A (WHNP)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:A
Last Name:KUCMIERZ
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-0145
Mailing Address - Country:US
Mailing Address - Phone:903-731-7000
Mailing Address - Fax:903-731-7016
Practice Address - Street 1:3215 W OAK ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8484
Practice Address - Country:US
Practice Address - Phone:903-731-7000
Practice Address - Fax:903-731-7016
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXKUCI-0432-0113363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXKUCI-0432-0113OtherNP LICENSE