Provider Demographics
NPI:1235101411
Name:TJEPKES, BARBARA ANN (WHNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:TJEPKES
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:BARB
Other - Middle Name:
Other - Last Name:TJEPKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6845 LEE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1717
Mailing Address - Country:US
Mailing Address - Phone:763-503-4400
Mailing Address - Fax:763-569-0311
Practice Address - Street 1:6845 LEE AVE N
Practice Address - Street 2:MAIL STOP 31400A
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1717
Practice Address - Country:US
Practice Address - Phone:763-569-0300
Practice Address - Fax:763-569-0330
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1189221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN383517100Medicaid
MN383517100Medicaid