Provider Demographics
NPI:1932203536
Name:RUPLEY, KATHRYNE F (DPM)
Entity Type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:F
Last Name:RUPLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 E HERNDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3377
Mailing Address - Country:US
Mailing Address - Phone:559-552-0522
Mailing Address - Fax:559-257-2886
Practice Address - Street 1:1642 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3377
Practice Address - Country:US
Practice Address - Phone:559-552-0522
Practice Address - Fax:559-257-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4479213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E44790OtherBLUE SHIELD
CAE4479OtherCALIFORNIA LICENSE
CAE44790OtherBLUE CROSS
CA000E44790Medicaid
611685500OtherDEPARTMENT OF LABOR
CA000E44791Medicare PIN
611685500OtherDEPARTMENT OF LABOR
CA000E44790OtherBLUE SHIELD
CAU96008Medicare UPIN