Individual
KIMBERLY RUTH TUPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
770 W LINCOLN HWY, EXTON, PA 19341-2547
(610) 269-1372
(610) 269-6951
Mailing address
770 W LINCOLN HWY, EXTON, PA 19341-2547
(610) 269-1372
(610) 269-6951
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OA000144L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232769426
TAX ID
PA
01
—
P00079110
RAILROAD MEDICARE
PA
Enumeration date
01/29/2007
Last updated
10/05/2007
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