Provider Demographics
NPI:1417251844
Name:EPPERSON, JENNIFER ROSE (RN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:RN, ANP-BC
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Mailing Address - Street 1:319 HOSPITAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1929
Mailing Address - Country:US
Mailing Address - Phone:276-634-4976
Mailing Address - Fax:
Practice Address - Street 1:4601 WHITESBURG DR SE STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1678
Practice Address - Country:US
Practice Address - Phone:256-880-1050
Practice Address - Fax:256-213-4681
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-149092363L00000X
VA0024169255363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901250Medicaid