MR. WILLARD KEITH CUPP PMHNP NPI 1265021406

NPI Information

NPI: 1265021406
Provider Name: MR. WILLARD KEITH CUPP, PMHNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
236 SIMPSON AVE
ELKHART, IN
ZIP 46516
Phone: (574) 293-0052
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MR. Willard Keith Cupp, PMHNP is a psychiatric/mental health nurse practitioner in Elkhart, IN with 4 years of experience. MR. Willard Keith Cupp, PMHNP NPI is 1265021406. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

236 SIMPSON AVE
ELKHART, IN
ZIP 46516-666
Phone: (574) 293-0052

The NPI 1265021406 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/12/2021 and was last updated on 11/3/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	71010753A	INDIANA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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