Healthcare Provider Details

I. General information

NPI: 1609836642
Provider Name (Legal Business Name): NINA L EPPERSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11004 E 40 HWY SUITE 123
INDEPENDENCE MO
64055-6023
US

IV. Provider business mailing address

1303 EDGEWOOD DR SUITE 101
JEFFERSON CITY MO
65109-1943
US

V. Phone/Fax

Practice location:
  • Phone: 816-356-2244
  • Fax: 816-356-4955
Mailing address:
  • Phone: 573-636-6727
  • Fax: 573-761-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY01535
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: