Provider Demographics
NPI:1225165491
Name:JEPPESEN, KYRA M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KYRA
Middle Name:M
Last Name:JEPPESEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48002
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-1002
Mailing Address - Country:US
Mailing Address - Phone:509-879-1512
Mailing Address - Fax:
Practice Address - Street 1:2020 E 29TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3917
Practice Address - Country:US
Practice Address - Phone:509-879-1512
Practice Address - Fax:509-443-4323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist