Healthcare Provider Details

I. General information

NPI: 1356162838
Provider Name (Legal Business Name): CATHERINE JEPSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE THOMAS

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTHERN BLVD STE 300
KETTERING OH
45429-1265
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-9299
  • Fax: 937-643-2343
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008997RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: