Provider Demographics
NPI:1962510412
Name:KUPEYAN, KRISTEN A (MD, MHSA)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:A
Last Name:KUPEYAN
Suffix:
Gender:F
Credentials:MD, MHSA
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:BLUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MHSA
Mailing Address - Street 1:853 N CHURCH ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3077
Mailing Address - Country:US
Mailing Address - Phone:864-560-6000
Mailing Address - Fax:
Practice Address - Street 1:4100 CENTER POINTE DR STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9460
Practice Address - Country:US
Practice Address - Phone:313-909-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL27207207Q00000X
FLME153506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine