Healthcare Provider Details

I. General information

NPI: 1588095590
Provider Name (Legal Business Name): MARY G EPPERSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD DIV NEUROLOGY PEDIATRICS, STE 1A
CHESTERFIELD MO
63017-5941
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6120
  • Fax: 314-454-4225
Mailing address:
  • Phone: 314-454-6120
  • Fax: 314-454-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number103040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: