Provider Demographics
NPI:1114335221
Name:MARK A JEPSON PLLC
Entity Type:Organization
Organization Name:MARK A JEPSON PLLC
Other - Org Name:MARK ALAN JEPSON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JEPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-391-1043
Mailing Address - Street 1:413 N ALLUMBAUGH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9212
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 N ALLUMBAUGH ST
Practice Address - Street 2:STE. 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:208-323-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-902A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty