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General NPI Number Information
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NPI Number | 1790143436
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Entity Type | Organization
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Legal Business Name | REVELSTONE FAMILY PRACTICE
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 232 CONCORD RD
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City | ALBEMARLE
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State | NC
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Zip | 28001-4612
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Country | US
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Telephone | 704-986-3900
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Fax | 704-986-3913
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Provider Business Mailing Address
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Address Line | 232 CONCORD RD
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City | ALBEMARLE
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State | NC
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Zip | 28001-4612
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Country | US
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Telephone | 704-986-3900
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Fax | 704-986-3913
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD ALLEN KEPP
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Credential | MD
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Telephone | 704-986-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9400873
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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