Provider Demographics
NPI:1538581541
Name:KUPLAST, FELICIA (NP)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:KUPLAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1022
Mailing Address - Country:US
Mailing Address - Phone:978-744-2999
Mailing Address - Fax:978-744-2993
Practice Address - Street 1:175 WALNUT RD
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1022
Practice Address - Country:US
Practice Address - Phone:508-954-4929
Practice Address - Fax:507-590-0431
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN168042363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health