Healthcare Provider Details

I. General information

NPI: 1952101925
Provider Name (Legal Business Name): SEDRICKA EPPERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 W JEFFERSON BLVD STE 125
FORT WAYNE IN
46804-6838
US

IV. Provider business mailing address

4656 W JEFFERSON BLVD STE 125
FORT WAYNE IN
46804-6838
US

V. Phone/Fax

Practice location:
  • Phone: 260-467-9837
  • Fax:
Mailing address:
  • Phone: 260-310-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28221899A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: