Provider Demographics
NPI:1225340946
Name:CUPP, JENNIFER KREPS (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KREPS
Last Name:CUPP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 ALABAMA HIGHWAY 157
Mailing Address - Street 2:SUITE 330 CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES, P.C
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0643
Mailing Address - Country:US
Mailing Address - Phone:256-739-1552
Mailing Address - Fax:256-739-8350
Practice Address - Street 1:1948 ALABAMA HIGHWAY 157
Practice Address - Street 2:SUITE 330 CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES, P.C
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0643
Practice Address - Country:US
Practice Address - Phone:256-739-3838
Practice Address - Fax:256-739-8350
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090307163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529903010Medicaid