Healthcare Provider Details

I. General information

NPI: 1669351052
Provider Name (Legal Business Name): KYRA KUPPLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CHURCH ST
WILKES BARRE PA
18702-3507
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-3100
  • Fax: 570-808-2539
Mailing address:
  • Phone: 570-808-3100
  • Fax: 570-808-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067231
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: