1700836129 NPI number — MR. KURT ANDREW KRUPNICK M.D.

Table of content: DR. LISA PRUSSICK MD (NPI 1609434950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700836129 NPI number — MR. KURT ANDREW KRUPNICK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUPNICK
Provider First Name:
KURT
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700836129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5327 CRESCENT EDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301-0105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-515-1755
Provider Business Mailing Address Fax Number:
928-277-1627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5327 CRESCENT EDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-0105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-515-1755
Provider Business Practice Location Address Fax Number:
928-277-1627
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  42104 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043346203 0078 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 317297 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 043346203012 . This is a "TRICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: KRUP11138661 . This is a "BC BS OF VERMONT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0VN1768 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com