Active NPI
Kimberly Ruth Tupper, PA
- Medical Physician Assistant
- Exton, PA
National Provider Identifier
1629114608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- OA000144L
- Practice address
- 770 W Lincoln Hwy
Exton, PA 19341-2547 - Phone
- (610) 269-1372
- Fax
- (610) 269-6951
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | OA000144L | PA | Primary |
Addresses
Primary practice location
770 W Lincoln Hwy
Exton, PA 19341-2547
Mailing address
770 W Lincoln Hwy
Exton, PA 19341-2547
Phone (610) 269-1372
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 232769426 | Other | PA | TAX ID |
| P00079110 | Other | PA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OA000144L | PA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191542400000",
"number": "1629114608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 W LINCOLN HWY",
"city": "EXTON",
"state": "PA",
"postal_code": "193412547",
"telephone_number": "610-269-1372",
"fax_number": "610-269-6951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 W LINCOLN HWY",
"city": "EXTON",
"state": "PA",
"postal_code": "193412547",
"telephone_number": "610-269-1372",
"fax_number": "610-269-6951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUPPER",
"first_name": "KIMBERLY",
"middle_name": "RUTH",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2007-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "OA000144L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "232769426",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00079110",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Exton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.