Provider Demographics
NPI:1215025895
Name:JEPSON, BRITTANY (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:JEPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:JEPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:121 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9292
Mailing Address - Country:US
Mailing Address - Phone:615-672-5575
Mailing Address - Fax:615-672-5405
Practice Address - Street 1:121 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9292
Practice Address - Country:US
Practice Address - Phone:615-672-5575
Practice Address - Fax:615-672-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3663880Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNQ52621Medicare UPIN