MEDICARE: KIMBRA ANN EPPS FNP

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	363LF0000X	Family Nurse Practitioner	89000514N1	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R103163	OTHER		MEDICARE PART B

General Provider Information

NPI Number	:	1154406064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBRA ANN EPPS FNP

Provider Business Mailing Address
First Line	:	1959 NE DIAMOND LAKE BLVD STE 109
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3573
Country	:	US
Telephone Number	:	541-492-1785
Fax Number	:	833-764-4112

Provider Business Practice Location Address
First Line	:	1959 NE DIAMOND LAKE BLVD STE 109
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3573
Country	:	US
Telephone Number	:	541-492-1785
Fax Number	:	833-764-4112

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/12/2026

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