Healthcare Provider Details

I. General information

NPI: 1073247482
Provider Name (Legal Business Name): MARY PAIGE KUPER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17350 ST LUKES WAY STE 380
THE WOODLANDS TX
77384-4167
US

IV. Provider business mailing address

1058 FOREST HAVEN CT
CONROE TX
77384-3500
US

V. Phone/Fax

Practice location:
  • Phone: 936-273-1600
  • Fax:
Mailing address:
  • Phone: 936-333-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1087035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: