NPIMap

Individual provider Active NPI

Kelli Jo Hupp, FNP-C

  • Family Nurse Practitioner
  • Dawes, WV
National Provider Identifier
1073255287
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
112500 Issued in WV
Practice address
5722 Cabin Creek Rd
Dawes, WV 25054-7700
Phone
(304) 595-5006
Fax
(304) 595-5007
NPI assigned
Apr 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 112500 WV Primary

Addresses

Primary practice location

5722 Cabin Creek Rd
Dawes, WV 25054-7700

Mailing address

104 Alex LN
Charleston, WV 25304-2952
Phone (304) 734-2040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230927001774 WV Practitioner - Nurse Practitioner 3870947625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cabin Creek Health Center Inc 41 clinicians

Practice addresses (Care Compare)

5722 Cabin Creek Rd
Dawes, WV 25054-7700
Phone (304) 595-5006

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
112500WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cabin Creek Health Center, Inc. CurrentSince Aug 15, 2023 Accepting new patients
Cabin Creek Health Center, Inc. CurrentSince Aug 15, 2023 Accepting new patients

Locations

1 Warrior Way
Ste 103
Belle, WV 25015
Phone (304) 949-3591

4602 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 205-7535

6135 Sissonville Dr
Charleston, WV 25312
Phone (304) 984-1576

104 Alex Ln
Charleston, WV 25304
Phone 30473420401319

107 Koontz Ave
Ste 200
Clendenin, WV 25045
Phone (304) 548-7272

Interoperability endpoints

  • Direct secure messaging: kelli.hupp.1@7267.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1073255287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ALEX LN",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253042952",
            "telephone_number": "304-734-2040",
            "fax_number": "304-734-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5722 CABIN CREEK RD",
            "city": "DAWES",
            "state": "WV",
            "postal_code": "250547700",
            "telephone_number": "304-595-5006",
            "fax_number": "304-595-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUPP",
        "first_name": "KELLI",
        "middle_name": "JO",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "112500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dawes, WV

Sources for this page

Verify at the official NPI Registry.