Provider Demographics
NPI:1548387640
Name:KEPPLER, BRENDA LEE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:KEPPLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 STATE ROUTE 335
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613
Mailing Address - Country:US
Mailing Address - Phone:740-226-3103
Mailing Address - Fax:
Practice Address - Street 1:407 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9771
Practice Address - Country:US
Practice Address - Phone:740-289-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341399Medicaid