Healthcare Provider Details

I. General information

NPI: 1053013730
Provider Name (Legal Business Name): KIMBERLY LYNN KUPCINSKI MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E PACES FERRY RD NE
ATLANTA GA
30305-2233
US

IV. Provider business mailing address

255 E PACES FERRY RD NE
ATLANTA GA
30305-2233
US

V. Phone/Fax

Practice location:
  • Phone: 443-995-5892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191590
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: