MEDICARE: MISS KRISTIN MARIE DUPRE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102560	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ND0LB	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215953674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTIN MARIE DUPRE P.A.

Provider Business Mailing Address
First Line	:	802 W MLK BLVD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-5105
Country	:	US
Telephone Number	:	813-754-1496
Fax Number	:	813-754-2553

Provider Business Practice Location Address
First Line	:	802 W MLK BLVD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-5105
Country	:	US
Telephone Number	:	813-754-1496
Fax Number	:	813-754-2553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/23/2019

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