Provider Demographics
NPI:1669436952
Name:CULPEPPER, KELIEGH SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KELIEGH
Middle Name:SUZANNE
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3477
Mailing Address - Country:US
Mailing Address - Phone:520-320-7681
Mailing Address - Fax:
Practice Address - Street 1:7485 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-320-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37485207ND0900X
MA217360207ND0900X
NH12960207ND0900X
NV11649207ND0900X
NY6291615207ND0900X
CT045886207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787194Medicaid
MAA35640Medicare ID - Type Unspecified
MA9787194Medicaid