Provider Demographics
NPI:1427456300
Name:KUPPINGER, PAUL HERBERT (MSN,FNP-BC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HERBERT
Last Name:KUPPINGER
Suffix:
Gender:M
Credentials:MSN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 E BASELINE RD
Mailing Address - Street 2:SUITE 203 BLDG 2
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2738
Mailing Address - Country:US
Mailing Address - Phone:480-300-5388
Mailing Address - Fax:
Practice Address - Street 1:3303 E BASELINE RD
Practice Address - Street 2:SUITE 203 BLDG 2
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2738
Practice Address - Country:US
Practice Address - Phone:480-300-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily