Healthcare Provider Details

I. General information

NPI: 1104575059
Provider Name (Legal Business Name): EMILY KEPFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MEDICAL PARK DR
BRIDGEPORT WV
26330-9006
US

IV. Provider business mailing address

327 MEDICAL PARK DR
BRIDGEPORT WV
26330-9006
US

V. Phone/Fax

Practice location:
  • Phone: 681-342-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5026
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number5026
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5026
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: