Individual
GERRI A KUKUCKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5224 SUNSET BLVD, LEXINGTON, SC 29072-9259
(803) 796-4251
(803) 796-4449
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
(803) 796-4251
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
24208
SC
363LF0000X
Family Nurse Practitioner
Primary
24208
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP8155
—
SC
Enumeration date
10/16/2020
Last updated
11/05/2024
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