Healthcare Provider Details

I. General information

NPI: 1669923843
Provider Name (Legal Business Name): EMILY D KUPER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 LIONESS WAY
PARKER CO
80134-5603
US

IV. Provider business mailing address

5023 W 120TH AVE STE 312
BROOMFIELD CO
80020-5606
US

V. Phone/Fax

Practice location:
  • Phone: 720-644-9355
  • Fax:
Mailing address:
  • Phone: 720-644-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992650
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: