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NPI 1396934451

NPI 1396934451 : STEPHANIE J EPPERSON PA-C : HEYWORTH, IL

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General NPI Number Information
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    NPI Number           |    1396934451
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    Entity Type          |    Individual 
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    Provider Name        |    STEPHANIE J EPPERSON PA-C
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    10/15/2007
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    Last Update Date     |    10/24/2025
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Provider Practice Location Address
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    Address Line         |    801 FOX RUN 
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    City                 |    HEYWORTH
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    State                |    IL
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    Zip                  |    61745-9345
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    Country              |    US
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    Telephone            |    309-473-2795
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    Fax                  |    309-473-3216
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Provider Business Mailing Address
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    Address Line         |    801 FOX RUN 
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    City                 |    HEYWORTH
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    State                |    IL
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    Zip                  |    61745-9345
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    Country              |    US
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    Telephone            |    309-473-2795
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    Fax                  |    309-473-3216
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    363AM0700X
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    Taxonomy Name        |    Medical Physician Assistant
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    License Number       |    085-003079
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    License Number State |    IL
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