Healthcare Provider Details

I. General information

NPI: 1396840179
Provider Name (Legal Business Name): VERNICE KEPPLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE #310
TAMPA FL
33607-6383
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4435
  • Fax: 813-870-4084
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-868-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1682302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: