Healthcare Provider Details

I. General information

NPI: 1639282684
Provider Name (Legal Business Name): CORINNE ANNE CUPPY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNE ANNE WATSON PA-C

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

5750 JOHNSTON ST STE 205
LAFAYETTE LA
70503-5345
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone: 337-991-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: