Provider Demographics
NPI:1427691757
Name:DUPREY, AUSTIN PEAK (PA-C)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:PEAK
Last Name:DUPREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 PINE MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4840
Mailing Address - Country:US
Mailing Address - Phone:740-361-7809
Mailing Address - Fax:
Practice Address - Street 1:701 TECH CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1987
Practice Address - Country:US
Practice Address - Phone:614-396-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006222RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant