Provider Demographics
NPI:1043062029
Name:KURKA, CODIE FAYE
Entity type:Individual
Prefix:
First Name:CODIE
Middle Name:FAYE
Last Name:KURKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CODIE
Other - Middle Name:FAYE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 POINT VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5564
Mailing Address - Country:US
Mailing Address - Phone:269-779-5530
Mailing Address - Fax:
Practice Address - Street 1:607 POINT VLY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5564
Practice Address - Country:US
Practice Address - Phone:269-779-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program