Individual
STANLEY J KUPCHINSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
135 W RAVINE RD, SUITE 5 B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 1308, KINGSPORT, TN 37662-1308
(423) 224-3460
(423) 224-3465
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9502
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
01
—
261969
ANTHEM BCBS
—
01
—
3046126
BLUE SHIELD OF TN
—
05
—
3605194
—
TN
01
—
74216938
KY MEDICAID
KY
05
—
9556184
—
VA
01
—
TN0100
JOHN DEERE
—
Enumeration date
09/13/2005
Last updated
07/09/2007
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