Provider Demographics
NPI:1801975354
Name:KUIPER, NICOLE RAE (PA C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:KUIPER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2311 N MESA
Mailing Address - Street 2:BUILDING F
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3575
Mailing Address - Country:US
Mailing Address - Phone:915-544-6400
Mailing Address - Fax:915-544-2836
Practice Address - Street 1:2311 N MESA
Practice Address - Street 2:BUILDING F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3575
Practice Address - Country:US
Practice Address - Phone:915-544-6400
Practice Address - Fax:915-544-2836
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant