Provider Demographics
NPI:1275855546
Name:KAPUSTINSKI, KATHRYN ELIZABETH (RPA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:KAPUSTINSKI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:STURGEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPA-C
Mailing Address - Street 1:151 SILVER HAWK CT
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-9206
Mailing Address - Country:US
Mailing Address - Phone:860-420-9985
Mailing Address - Fax:
Practice Address - Street 1:151 SILVER HAWK CT
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-9206
Practice Address - Country:US
Practice Address - Phone:860-420-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant