Provider Demographics
NPI:1275715682
Name:KEPLIN, JENNIFER L (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KEPLIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1149
Mailing Address - Country:US
Mailing Address - Phone:701-477-0458
Mailing Address - Fax:701-477-0488
Practice Address - Street 1:1015 HOSPITAL RD. SUITE A
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-0458
Practice Address - Fax:701-477-0488
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27194363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459437Medicaid