Doctor Name: | JENNIFER L RUPPERSBERG |
NPI Number: | 1013004308 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA719 |
Business Practice Address: | 85 N Grand Ave Fort Thomas, KY - 410751793 |
Business Phone Number: | 8595723617 |
Business Fax Number: | 8595722366 |
Mailing Address: | 85 N Grand Ave, FORT THOMAS |
State: | KY |
Postal Code: | 410751793 |
Phone Number: | 8595723617 |
Fax Number: | 8595722366 |
NPI Enumeration Date: | 10/06/2006 |
NPI Last Update Date: | 06/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA719 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |