Healthcare Provider Details

I. General information

NPI: 1700500170
Provider Name (Legal Business Name): KALI LYN HEPNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 OPEN HEARTH DR
READING PA
19607-9446
US

IV. Provider business mailing address

14 OPEN HEARTH DR
READING PA
19607-9446
US

V. Phone/Fax

Practice location:
  • Phone: 484-599-0613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063826
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: