Healthcare Provider Details

I. General information

NPI: 1316939036
Provider Name (Legal Business Name): MICHAEL AVERY KEPLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL AVE
JEFFERSON NC
28640-9244
US

IV. Provider business mailing address

200 HOSPITAL AVE
JEFFERSON NC
28640-9244
US

V. Phone/Fax

Practice location:
  • Phone: 336-846-0821
  • Fax:
Mailing address:
  • Phone: 336-846-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27876
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: