1962093195 NPI number — MRS. AMY ZICKEFOOSE KUPSCO FNP

Table of content: JOSEPH SICARD PA (NPI 1376955096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962093195 NPI number — MRS. AMY ZICKEFOOSE KUPSCO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUPSCO
Provider First Name:
AMY
Provider Middle Name:
ZICKEFOOSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

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:
1962093195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28237-7938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-332-0396
Provider Business Mailing Address Fax Number:
704-971-0035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3158 FREEDOM DR STE 3101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28208-0014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-348-2992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2021

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: 363LF0000X , with the licence number:  F01211463 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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