Provider Demographics
NPI:1639282684
Name:CUPPY, CORINNE ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ANNE
Last Name:CUPPY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CORINNE
Other - Middle Name:ANNE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6608 MERCY CT
Mailing Address - Street 2:STE B
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3171
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:
Practice Address - Street 1:201 29TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3271
Practice Address - Country:US
Practice Address - Phone:916-446-6921
Practice Address - Fax:916-446-0640
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant