Healthcare Provider Details

I. General information

NPI: 1093053852
Provider Name (Legal Business Name): CHELSEY LINETTE KUPER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SAINT MARYS DR SUITE 205W
EVANSVILLE IN
47714-0511
US

IV. Provider business mailing address

801 SAINT MARYS DR SUITE 205W
EVANSVILLE IN
47714-0511
US

V. Phone/Fax

Practice location:
  • Phone: 812-469-3283
  • Fax: 812-469-3285
Mailing address:
  • Phone: 812-477-6103
  • Fax: 812-477-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37002259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: