Mary Lael Kucera, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00273 Issued in TX

Practice address

508 Medical Center Blvd
Conroe, TX 77304-2808

Phone

(936) 760-8543

Fax

(936) 521-7389

NPI assigned

Jun 6, 2006

Last updated

Jan 16, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200441600000",
    "number": "1922047885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 MEDICAL CENTER BLVD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042808",
            "telephone_number": "936-760-8543",
            "fax_number": "936-521-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 MEDICAL CENTER BLVD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042808",
            "telephone_number": "936-760-8543",
            "fax_number": "936-521-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUCERA",
        "first_name": "MARY",
        "middle_name": "LAEL",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2008-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA00273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kroger Texas L P (Kroger Pharmacy)
• Derek Gene Kroll, DO
• Alaura Krukoski
• Tracy Krupp, RBT
• Theodore John Krzysik, MSN, APRN, FNP-BC
• Tyler Lee Kucera
• James Nicholas Kuciemba, PHD
• Craig C Kuglen Jr., M.D.
• Mia Kuklin
• Shonesty Kuku

• Medical Physician Assistant in Conroe, TX
• Providers in Conroe, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.