Provider Demographics
NPI:1003257189
Name:MARC KEPNER LLC
Entity Type:Organization
Organization Name:MARC KEPNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-226-8210
Mailing Address - Street 1:9224 NW 59TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2880
Mailing Address - Country:US
Mailing Address - Phone:352-226-8210
Mailing Address - Fax:
Practice Address - Street 1:9224 NW 59TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-2880
Practice Address - Country:US
Practice Address - Phone:352-226-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8035103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty