Provider Demographics
NPI:1528649324
Name:KUCKLER, KEENAN NICHOLE (MD)
Entity type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:NICHOLE
Last Name:KUCKLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KEENAN
Other - Middle Name:NICHOLE
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 E ALKALI CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2766
Mailing Address - Country:US
Mailing Address - Phone:406-861-4139
Mailing Address - Fax:
Practice Address - Street 1:221 5TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2600
Practice Address - Country:US
Practice Address - Phone:406-228-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT142743207Q00000X
WY189-T1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine