Provider Demographics
NPI:1912570557
Name:RUPPERT, RACHAEL (PMHNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:RUPPERT
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SWEET HOME RD STE 1&2
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2777
Mailing Address - Country:US
Mailing Address - Phone:716-449-0494
Mailing Address - Fax:716-627-5860
Practice Address - Street 1:1400 SWEET HOME RD STE 1&2
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2777
Practice Address - Country:US
Practice Address - Phone:716-449-0494
Practice Address - Fax:716-985-9088
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403501363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1497828461Medicaid