Healthcare Provider Details

I. General information

NPI: 1861218042
Provider Name (Legal Business Name): NATHAN JEPSEN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SHEPHARD RD
CHARLEMONT MA
01339-9720
US

IV. Provider business mailing address

63 SHEPHARD RD
CHARLEMONT MA
01339-9720
US

V. Phone/Fax

Practice location:
  • Phone: 413-325-5264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: