Healthcare Provider Details

I. General information

NPI: 1225340946
Provider Name (Legal Business Name): JENNIFER KREPS CUPP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 ALABAMA HIGHWAY 157 SUITE 330 CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES, P.C
CULLMAN AL
35058-0643
US

IV. Provider business mailing address

1948 ALABAMA HIGHWAY 157 SUITE 330 CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES, P.C
CULLMAN AL
35058-0643
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-3838
  • Fax: 256-739-8350
Mailing address:
  • Phone: 256-739-1552
  • Fax: 256-739-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-090307
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: