Healthcare Provider Details

I. General information

NPI: 1164718615
Provider Name (Legal Business Name): KELLY ANN HEPPERT D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8474 WINTON RD
CINCINNATI OH
45231-4939
US

IV. Provider business mailing address

8474 WINTON RD
CINCINNATI OH
45231-4939
US

V. Phone/Fax

Practice location:
  • Phone: 513-728-4800
  • Fax: 513-728-4601
Mailing address:
  • Phone: 513-728-4800
  • Fax: 513-728-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003711
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: