Individual
CRISTY CUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
135 S PENN AVE, HARRISVILLE, WV 26362-1371
(304) 643-4005
Mailing address
8 MEMORY LN, ELLENBORO, WV 26346-6733
(478) 955-6621
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
108277
WV
363LF0000X
Family Nurse Practitioner
RN239073
GA
Other
Enumeration date
09/24/2020
Last updated
06/18/2024
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