Provider Demographics
NPI:1598372401
Name:CUPP, CRISTY (NP)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:CUPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CRISTY
Other - Middle Name:LYNN
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:8 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26346-6733
Mailing Address - Country:US
Mailing Address - Phone:478-955-6621
Mailing Address - Fax:
Practice Address - Street 1:135 S PENN AVE
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-1371
Practice Address - Country:US
Practice Address - Phone:304-643-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239073363LF0000X
WV108277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily