Provider Demographics
NPI:1578281820
Name:KUCERA, KAITLIN TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:TAYLOR
Last Name:KUCERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6176
Mailing Address - Country:US
Mailing Address - Phone:979-731-5200
Mailing Address - Fax:979-731-5210
Practice Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6176
Practice Address - Country:US
Practice Address - Phone:979-731-5200
Practice Address - Fax:979-731-5210
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA18368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program