Healthcare Provider Details

I. General information

NPI: 1811975428
Provider Name (Legal Business Name): CHRISTOPHER A KUPPER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CORNERSTONE BLVD
EDINBURG TX
78539-8301
US

IV. Provider business mailing address

2101 CORNERSTONE BLVD
EDINBURG TX
78539-8301
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-4151
  • Fax: 956-682-4154
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number685976
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: