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NPI Code Detail

MEDICARE: RILEY SHEA JEPKEMA

MEDICARE: RILEY SHEA JEPKEMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1154262863
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY SHEA JEPKEMA
Provider Business Mailing Address
First Line : 8159 S 8TH ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-9726
Country : US
Telephone Number : 269-254-3335
Fax Number :
Provider Business Practice Location Address
First Line : 111 COLCHESTER AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-847-0392
Fax Number : 802-847-3509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ RILEY SHEA JEPKEMA ” Practice Location

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