Provider Demographics
NPI:1962832527
Name:HUPP, KIMBERLY MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:HUPP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67925 BANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9301
Mailing Address - Country:US
Mailing Address - Phone:740-699-1000
Mailing Address - Fax:740-699-1004
Practice Address - Street 1:67925 BANFIELD RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9301
Practice Address - Country:US
Practice Address - Phone:740-699-1000
Practice Address - Fax:740-699-1004
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily