Healthcare Provider Details

I. General information

NPI: 1144812546
Provider Name (Legal Business Name): COLLEEN ANN KUPESKY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 02/07/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 ACADEMY RD
POWHATAN VA
23139-5820
US

IV. Provider business mailing address

2466 ACADEMY RD
POWHATAN VA
23139-5820
US

V. Phone/Fax

Practice location:
  • Phone: 804-399-9037
  • Fax:
Mailing address:
  • Phone: 804-399-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001165805
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number0015001099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: