Healthcare Provider Details

I. General information

NPI: 1699600205
Provider Name (Legal Business Name): DESTINEY KUPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

10298 BCR 530
ZALMA MO
63787-8752
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-4822
  • Fax:
Mailing address:
  • Phone: 910-703-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026016759
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: