Individual
GERALD LYNN KUECKELHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2505 MISSION DR, JEFFERSON CITY, MO 65109-9508
(573) 636-3483
(573) 636-3386
Mailing address
1445 CHRISTY DR, JEFFERSON CITY, MO 65101-2853
(573) 636-3483
(573) 636-5315
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
076407
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430050775
RR MEDICARE
MO
05
—
913912416
—
MO
Enumeration date
09/26/2005
Last updated
01/26/2016
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