MEDICARE: KEPSON GERMAIN AGPCNP

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
1	363LP2300X	Primary Care Nurse Practitioner	R224056	MD
2	363LA2200X	Adult Health Nurse Practitioner	R224056	MD
3	363LG0600X	Gerontology Nurse Practitioner	R224056	MD

General Provider Information

NPI Number	:	1780364232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEPSON GERMAIN AGPCNP

Provider Business Mailing Address
First Line	:	730 MCNEIL LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-4066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7610 CARROLL AVE STE 270
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6302
Country	:	US
Telephone Number	:	301-270-4360
Fax Number	:	301-270-4319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	11/07/2023

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Directions to “ KEPSON GERMAIN AGPCNP” Practice Location

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