Provider Demographics
NPI:1851381644
Name:KUETER, SHAUN LEIGH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUN
Middle Name:LEIGH
Last Name:KUETER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 HIGHWAY 41A S
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6800
Mailing Address - Country:US
Mailing Address - Phone:870-378-3726
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-956-0392
Practice Address - Fax:270-956-0737
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000017577363LF0000X
ARA03004ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily