Provider Demographics
NPI:1417524547
Name:KUPNESKI, TAYLOR MACKENZIE (MS, CGC)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:MACKENZIE
Last Name:KUPNESKI
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37642
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 HOSPITAL DR STE 370
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5293
Practice Address - Country:US
Practice Address - Phone:843-883-1007
Practice Address - Fax:843-883-1016
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20203170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGC46OtherGENETIC COUNSELOR STATE LICENSURE
20203OtherAMERICAN BOARD OF GENETIC COUNSELING CERTIFICATE