Provider Demographics
NPI:1588806582
Name:CUPIT, ELLEN FRANCES (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:FRANCES
Last Name:CUPIT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:FRANCES
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:11912 KANIS RD
Mailing Address - Street 2:STE F2
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3733
Mailing Address - Country:US
Mailing Address - Phone:501-227-8020
Mailing Address - Fax:501-227-8826
Practice Address - Street 1:11912 KANIS RD
Practice Address - Street 2:SUITE F2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3733
Practice Address - Country:US
Practice Address - Phone:501-227-8020
Practice Address - Fax:501-227-8826
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical