Healthcare Provider Details

I. General information

NPI: 1942731559
Provider Name (Legal Business Name): TERIEA KUPIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 S MASON MONTGOMERY RD
MASON OH
45040-3706
US

IV. Provider business mailing address

6010 S MASON MONTGOMERY RD
MASON OH
45040-3706
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-204-6355
Mailing address:
  • Phone: 513-246-7000
  • Fax: 513-204-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020402
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020402
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: