Provider Demographics
NPI:1033351895
Name:JEPPSON, REBECCA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 S 7TH W
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-5060
Mailing Address - Country:US
Mailing Address - Phone:208-356-6185
Mailing Address - Fax:208-356-0378
Practice Address - Street 1:15 MADISON PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-2057
Practice Address - Country:US
Practice Address - Phone:208-356-6185
Practice Address - Fax:208-356-0378
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN16709163W00000X
IDNP920A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse