Healthcare Provider Details

I. General information

NPI: 1356642672
Provider Name (Legal Business Name): LEILA RICHELLE HEPP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 E HIGHWAY 54 STE E
ATHOL ID
83801-6085
US

IV. Provider business mailing address

6101 E HIGHWAY 54 STE E
ATHOL ID
83801-6085
US

V. Phone/Fax

Practice location:
  • Phone: 855-928-8778
  • Fax: 857-270-7313
Mailing address:
  • Phone: 855-928-8778
  • Fax: 857-270-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number75282
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75282
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60194889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: