MEDICARE: DR. LORA E PEPPARD PHD, DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024168567	VA

General Provider Information

NPI Number	:	1093766214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORA E PEPPARD PHD, DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	4400 UNIVERSITY DRIVE, MS 3C4
Second Line	:	GEORGE MASON UNIVERSITY
City	:	FAIRFAX
State	:	VA
Zip	:	22030
Country	:	US
Telephone Number	:	703-993-5154
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 N GLEBE RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-4224
Country	:	US
Telephone Number	:	703-284-1610
Fax Number	:	703-284-3816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/07/2022

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