Healthcare Provider Details

I. General information

NPI: 1396934451
Provider Name (Legal Business Name): STEPHANIE J EPPERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE J RAYCRAFT PA-C

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 FOX RUN
HEYWORTH IL
61745-9345
US

IV. Provider business mailing address

801 FOX RUN
HEYWORTH IL
61745-9345
US

V. Phone/Fax

Practice location:
  • Phone: 309-473-2795
  • Fax: 309-473-3216
Mailing address:
  • Phone: 309-473-2795
  • Fax: 309-473-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003079
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-003079
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: