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1811675960
CHARLES JACOB CUPP
MADISONVILLE, TN
NPI
1811675960
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: TN 34212)
Enumeration Date
2023-07-10
Last Update Date
2023-10-26
Business Address
CHARLES JACOB CUPP FNP
167 WARREN ST
MADISONVILLE, TN 37354-3001
Phone number: 423-442-5480
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Mailing Address
CHARLES JACOB CUPP FNP
1275 DICK LONAS RD UNIT 101
KNOXVILLE, TN 37909-1383
Phone number: 865-584-4747
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