Provider Demographics
NPI:1578028262
Name:EPPENGER, WILLIE A
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:A
Last Name:EPPENGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2348
Mailing Address - Country:US
Mailing Address - Phone:662-712-6257
Mailing Address - Fax:
Practice Address - Street 1:6209 A HWY 310
Practice Address - Street 2:
Practice Address - City:COMO
Practice Address - State:MS
Practice Address - Zip Code:38619
Practice Address - Country:US
Practice Address - Phone:662-288-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health