Provider Demographics
NPI:1629416656
Name:JUPSON, VERONICA AUSTRIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:AUSTRIA
Last Name:JUPSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COUNTRY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4065
Mailing Address - Country:US
Mailing Address - Phone:901-466-7724
Mailing Address - Fax:
Practice Address - Street 1:2960B AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5602
Practice Address - Country:US
Practice Address - Phone:901-372-7878
Practice Address - Fax:901-373-9298
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000079499163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)