Healthcare Provider Details

I. General information

NPI: 1558856310
Provider Name (Legal Business Name): STEFANIE PEPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 WEST BEACON ST.
PHILADELPHIA MS
38350
US

IV. Provider business mailing address

PO BOX 1258
WAYNESBORO TN
38485-1258
US

V. Phone/Fax

Practice location:
  • Phone: 769-200-0730
  • Fax: 769-200-0731
Mailing address:
  • Phone: 931-253-1110
  • Fax: 931-722-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902716
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: