Provider Demographics
NPI:1356674048
Name:ZEPEDA, CODY LEE (DC, AGACNP)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:LEE
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:DC, AGACNP
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:LEE
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, AGACNP
Mailing Address - Street 1:432 CIRCLEVIEW DR S
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3525
Mailing Address - Country:US
Mailing Address - Phone:479-236-9635
Mailing Address - Fax:
Practice Address - Street 1:432 CIRCLEVIEW DR S
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3525
Practice Address - Country:US
Practice Address - Phone:479-236-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11233111N00000X
TXAP143328363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No111N00000XChiropractic ProvidersChiropractor
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner