Individual
MR. WILLARD KEITH CUPP III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 293-0052
Mailing address
236 SIMPSON AVE, ELKHART, IN 46516-4666
(574) 968-2461
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71010753A
IN
Other
Enumeration date
01/12/2021
Last updated
11/03/2023
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