Provider Demographics
NPI:1164718615
Name:HEPPERT, KELLY ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:HEPPERT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8474 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4939
Mailing Address - Country:US
Mailing Address - Phone:513-728-4800
Mailing Address - Fax:513-728-4601
Practice Address - Street 1:8474 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4939
Practice Address - Country:US
Practice Address - Phone:513-728-4800
Practice Address - Fax:513-728-4601
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003711213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109176Medicaid
OHH363480Medicare PIN
OH0109176Medicaid