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General NPI Number Information
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NPI Number | 1396724191
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Entity Type | Individual
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Provider Name | DAVID THOMAS RUPERT CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 166 MEMORIAL CT
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City | JACKSONVILLE
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State | NC
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Zip | 28546-3209
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Country | US
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Telephone | 910-353-9565
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAMPSHIRE PL
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City | JACKSONVILLE
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State | NC
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Zip | 28546-3209
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Country | US
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Telephone | 910-353-2863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 124495
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License Number State | NC
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