Provider Demographics
NPI:1366530628
Name:CUPP, BRENDA M (DNP)
Entity type:Individual
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First Name:BRENDA
Middle Name:M
Last Name:CUPP
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Gender:F
Credentials:DNP
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Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 320-330
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-781-5387
Mailing Address - Fax:417-781-7174
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:SUITE 320-330
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-5387
Practice Address - Fax:417-781-7174
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-11-17
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Provider Licenses
StateLicense IDTaxonomies
MO123412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200096720AMedicaid
MO424021004Medicaid
KS200406720BMedicaid
KS200406720BMedicaid