Provider Demographics
NPI:1730770652
Name:KUEPER, MALARIE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:MALARIE
Middle Name:LYNN
Last Name:KUEPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:BARTELSO
Mailing Address - State:IL
Mailing Address - Zip Code:62218-0184
Mailing Address - Country:US
Mailing Address - Phone:618-301-6278
Mailing Address - Fax:
Practice Address - Street 1:8011 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1119
Practice Address - Country:US
Practice Address - Phone:314-260-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine