Provider Demographics
NPI:1275521593
Name:RUPE, LARRY E (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:E
Last Name:RUPE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 4TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2448
Mailing Address - Country:US
Mailing Address - Phone:931-528-7877
Mailing Address - Fax:
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2448
Practice Address - Country:US
Practice Address - Phone:931-528-7877
Practice Address - Fax:931-526-3261
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000044208367500000X
TN8945367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74289257Medicaid
TN3026920OtherBCBST
TN3602647Medicaid
TN3602641Medicare PIN