Provider Demographics
NPI:1003492778
Name:HEPWORTH, TESSIE (APRN, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TESSIE
Middle Name:
Last Name:HEPWORTH
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC
Other - Prefix:MS
Other - First Name:TESSIE
Other - Middle Name:JO
Other - Last Name:EMBRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:
Practice Address - Street 1:3430 NEWBURG RD STE 150
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2497
Practice Address - Country:US
Practice Address - Phone:502-459-9127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015888363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care