Provider Demographics
NPI:1932836111
Name:KUCERA, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:KUCERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:RIPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4261 INDIANGRASS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3000
Mailing Address - Country:US
Mailing Address - Phone:402-871-9441
Mailing Address - Fax:
Practice Address - Street 1:4261 INDIANGRASS RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3000
Practice Address - Country:US
Practice Address - Phone:402-871-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-22-228444106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician