Healthcare Provider Details

I. General information

NPI: 1891659371
Provider Name (Legal Business Name): MISSY RENEE REPP AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 COUNTY ROAD 1095
ASHLAND OH
44805-9593
US

IV. Provider business mailing address

1612 COUNTY ROAD 1095
ASHLAND OH
44805-9593
US

V. Phone/Fax

Practice location:
  • Phone: 330-201-0803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0040914
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: