Provider Demographics
NPI:1295825404
Name:KUPPUSAMI, BETTY J (CNOR RNFA)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:KUPPUSAMI
Suffix:
Gender:F
Credentials:CNOR RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WINDSOR CIR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-9324
Mailing Address - Country:US
Mailing Address - Phone:276-326-3356
Mailing Address - Fax:
Practice Address - Street 1:109 WINDSOR CIR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-9324
Practice Address - Country:US
Practice Address - Phone:276-326-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31425163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant