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General NPI Number Information
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NPI Number | 1528423563
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Entity Type | Individual
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Provider Name | JENNIFER CUPPS APRN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 18 CORPORATE HILL DR SUITE 203
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-225-0917
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Fax |
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Provider Business Mailing Address
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Address Line | 38 ORCHID LANE
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City | CABOT
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State | AR
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Zip | 72023
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Country | US
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Telephone | 501-416-2693
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | A004571
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License Number State | AR
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