Provider Demographics
NPI:1972959096
Name:KUCK, TRYNNA LYNN (RN,IBCLC)
Entity Type:Individual
Prefix:
First Name:TRYNNA
Middle Name:LYNN
Last Name:KUCK
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SIGNATURE POINT DR
Mailing Address - Street 2:APT 207
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6508
Mailing Address - Country:US
Mailing Address - Phone:281-755-1866
Mailing Address - Fax:
Practice Address - Street 1:1 SIGNATURE POINT DR
Practice Address - Street 2:APT 207
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6508
Practice Address - Country:US
Practice Address - Phone:281-755-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11122208OtherIBCLC
TX533482OtherRN LICENSE