Provider Demographics
NPI:1679778260
Name:KUEPPER, CAROLINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:KUEPPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 E SINTON ST
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-2928
Mailing Address - Country:US
Mailing Address - Phone:361-364-2804
Mailing Address - Fax:361-364-5014
Practice Address - Street 1:1143 E SINTON ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2928
Practice Address - Country:US
Practice Address - Phone:361-364-2804
Practice Address - Fax:361-364-5014
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342232101Medicaid
TX377483YLPSOtherWELLMED PTAN
TX112554401Medicaid
TX813753OtherBCBS
CP2136Medicare PIN
TX112554401Medicaid