Provider Demographics
NPI:1104119288
Name:KUIPERS, AUSTIN NELSON (PA-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:NELSON
Last Name:KUIPERS
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 228
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 GRANDVILLE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4920
Practice Address - Country:US
Practice Address - Phone:616-685-8400
Practice Address - Fax:616-742-1322
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2021-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant