Provider Demographics
NPI:1043383326
Name:SCHEPPER, GARY S (FNP, CS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:S
Last Name:SCHEPPER
Suffix:
Gender:M
Credentials:FNP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2112
Mailing Address - Country:US
Mailing Address - Phone:812-333-2995
Mailing Address - Fax:
Practice Address - Street 1:2455 OLD STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-8177
Practice Address - Country:US
Practice Address - Phone:812-988-6678
Practice Address - Fax:812-988-1599
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000687A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN420656Medicaid
IN420656Medicaid
INPO9223Medicare UPIN