MEDICARE: PRECIOUS KATHRYN HEPBURN

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	376K00000X	Nurse's Aide	CNA222466	FL

General Provider Information

NPI Number	:	1801721618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRECIOUS KATHRYN HEPBURN

Provider Business Mailing Address
First Line	:	2516 WILKINS AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-2482
Country	:	US
Telephone Number	:	772-227-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 WILKINS AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-2482
Country	:	US
Telephone Number	:	772-227-0980
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ PRECIOUS KATHRYN HEPBURN ” Practice Location

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