| Upper Mattaponi Indian Tribe | |
|
7864 Richmond Tappahannock Hwy Aylett VA 23009-3056 | |
| (804) 769-2015 | |
| Not Available |
| Full Name | Upper Mattaponi Indian Tribe |
|---|---|
| Speciality | Family Medicine |
| Location | 7864 Richmond Tappahannock Hwy, Aylett, Virginia |
| Authorized Official Name and Position | Steven Family Tupponce (DIRECTOR) |
| Authorized Official Contact | 8043474109 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upper Mattaponi Indian Tribe 13476 King William Rd King William VA 23086-3401 Ph: (804) 769-0041 | Upper Mattaponi Indian Tribe 7864 Richmond Tappahannock Hwy Aylett VA 23009-3056 Ph: (804) 769-2015 |
| NPI Number | 1750969168 |
|---|---|
| Provider Enumeration Date | 03/30/2021 |
| Last Update Date | 07/17/2025 |
| Certification Date | 07/17/2025 |
| Medicare PECOS PAC ID | 4880091446 |
|---|---|
| Medicare Enrollment ID | O20210923002671 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750969168 | NPI | - | NPPES |
| Provider Name | Alan K Tupponce |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578651089 PECOS PAC ID: 0547398786 Enrollment ID: I20100510000665 |
| Provider Name | James H Towe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588658108 PECOS PAC ID: 8325012305 Enrollment ID: I20210923002941 |
| Provider Name | Irene Molyneux Temple |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174664429 PECOS PAC ID: 6709823081 Enrollment ID: I20241009001250 |
| Provider Name | Caitlin Mackenzie O'conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811732399 PECOS PAC ID: 6800328212 Enrollment ID: I20241010000261 |
| Provider Name | Joynita Nicholson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1265462782 PECOS PAC ID: 5395718571 Enrollment ID: I20241015004748 |
| Provider Name | Lori Ha |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1750722682 PECOS PAC ID: 4587933213 Enrollment ID: I20241104001455 |
| Provider Name | Raven Custalow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669955019 PECOS PAC ID: 0840543013 Enrollment ID: I20241104002126 |
| Provider Name | Jessica Marie Jemison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598450678 PECOS PAC ID: 9739601154 Enrollment ID: I20250314001671 |
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