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General NPI Number Information
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NPI Number | 1114335221
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Entity Type | Organization
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Legal Business Name | MARK A JEPSON PLLC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 413 N ALLUMBAUGH ST STE. 101
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City | BOISE
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State | ID
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Zip | 83704-9212
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Country | US
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Telephone | 208-323-1125
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Fax | 208-323-9604
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Provider Business Mailing Address
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Address Line | 413 N ALLUMBAUGH ST STE. 101
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City | BOISE
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State | ID
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Zip | 83704-9212
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Country | US
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Telephone | 208-323-1125
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Fax | 208-323-9604
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Authorized Official
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Title or Position | OWNER
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Name | MARK ALAN JEPSON
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Credential | NP
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Telephone | 208-391-1043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | NP-902A
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License Number State | ID
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