Stephanie Margaret Kuckuck, RN

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

License

553962-1 Issued in NY

Practice address

2414 S State Road 5
Larwill, IN 46764-9766

Phone

(260) 723-4179

Fax

(260) 723-4101

NPI assigned

Nov 30, 2007

Last updated

Nov 30, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196380800000",
    "number": "1154503167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2414 S STATE ROAD 5",
            "city": "LARWILL",
            "state": "IN",
            "postal_code": "467649766",
            "telephone_number": "260-723-4179",
            "fax_number": "260-723-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 S STATE ROAD 5",
            "city": "LARWILL",
            "state": "IN",
            "postal_code": "467649766",
            "telephone_number": "260-723-4179",
            "fax_number": "260-723-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCKUCK",
        "first_name": "STEPHANIE",
        "middle_name": "MARGARET",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "NY",
            "license": "553962-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.