Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Willard Keith Cupp III, PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1265021406

Mr. Willard Keith Cupp III, PMHNP is a Nurse Practitioner in Elkhart, Indiana. Qualified in 2020, 6 years ago. Practices with Heart City Health Center Inc, a 15-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
6
Licensed in
IN
In the registry since
2021
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

236 Simpson Ave
Elkhart, IN 46516-4666
Phone: (574) 293-0052
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 71010753A (IN)

Record details

NPI number1265021406
Entity typeIndividual (Type 1)
GenderMale
Credentials PMHNP
Sole proprietorNo
NPI enumeratedJanuary 12, 2021
Last updated in NPPESNovember 3, 2023
Certification dateAugust 3, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Heart City Health Center Inc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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