Provider Demographics
NPI:1639928302
Name:CULPS, JEROME JONATHAN JR
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:JONATHAN
Last Name:CULPS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N NACHES AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2451
Mailing Address - Country:US
Mailing Address - Phone:509-945-9337
Mailing Address - Fax:
Practice Address - Street 1:315 N 2ND ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2334
Practice Address - Country:US
Practice Address - Phone:509-643-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist