MEDICARE: MS. CAROLINE KUEPPER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA02185	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	377483YLPS	OTHER	TX	WELLMED PTAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	813753	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679778260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINE KUEPPER PA-C

Provider Business Mailing Address
First Line	:	1143 E SINTON ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2928
Country	:	US
Telephone Number	:	361-364-2804
Fax Number	:	361-364-5014

Provider Business Practice Location Address
First Line	:	1143 E SINTON ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2928
Country	:	US
Telephone Number	:	361-364-2804
Fax Number	:	361-364-5014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	10/15/2015

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