Provider Demographics
NPI:1003856725
Name:EPPERSON, HEIDI MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 CHATEAU DR.
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-3936
Mailing Address - Country:US
Mailing Address - Phone:479-621-8180
Mailing Address - Fax:479-621-8506
Practice Address - Street 1:500 TIGER BLVD.
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-254-5065
Practice Address - Fax:479-271-1123
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 16152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR126411721Medicaid
AR5U213OtherBLUE CROSS