Provider Demographics
NPI:1457817249
Name:KEPPER, JENNIFER WILSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILSON
Last Name:KEPPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35055 LA HIGHWAY 16 STE 2G
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1535
Mailing Address - Country:US
Mailing Address - Phone:225-271-1040
Mailing Address - Fax:888-571-3199
Practice Address - Street 1:35055 LA HIGHWAY 16 STE 2G
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1535
Practice Address - Country:US
Practice Address - Phone:225-271-1040
Practice Address - Fax:888-571-3199
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily