MEDICARE: JENNIFER WILSON KEPPER FNP-C

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	203423	LA

General Provider Information

NPI Number	:	1457817249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WILSON KEPPER FNP-C

Provider Business Mailing Address
First Line	:	35055 LA HIGHWAY 16 STE 2G
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1535
Country	:	US
Telephone Number	:	225-271-1040
Fax Number	:	888-571-3199

Provider Business Practice Location Address
First Line	:	35055 LA HIGHWAY 16 STE 2G
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1535
Country	:	US
Telephone Number	:	225-271-1040
Fax Number	:	888-571-3199

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

Provider Enumeration Date	:	02/16/2019
Last Update Date	:	09/28/2023

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