Doctor Name: | KELSEY ROSE HUPP |
NPI Number: | 1003169285 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | AP60311605 |
Business Practice Address: | 335 Fairview St Silverton, OR - 973811916 |
Business Phone Number: | 5038738686 |
Business Fax Number: | |
Mailing Address: | 335 Fairview St, SILVERTON |
State: | OR |
Postal Code: | 973811916 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/24/2012 |
NPI Last Update Date: | 06/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60311605 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |