Provider Demographics
NPI:1063892677
Name:RUPP, JAYDA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:JAYDA
Middle Name:MICHELLE
Last Name:RUPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:2200 SW 6TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1707
Practice Address - Country:US
Practice Address - Phone:785-354-8518
Practice Address - Fax:785-354-1255
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76793-081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner