Provider Demographics
NPI:1750865192
Name:HUPP, KELSEY MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIE
Last Name:HUPP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:RICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:112 BULOW DR
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3806
Mailing Address - Country:US
Mailing Address - Phone:605-515-3491
Mailing Address - Fax:
Practice Address - Street 1:100 MAC LN
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3391
Practice Address - Country:US
Practice Address - Phone:605-224-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily