Provider Demographics
NPI:1598310690
Name:KEPLER, GLENDA JANE MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:JANE MARIE
Last Name:KEPLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:HADDOCK
Mailing Address - State:GA
Mailing Address - Zip Code:31033-2437
Mailing Address - Country:US
Mailing Address - Phone:478-501-2301
Mailing Address - Fax:
Practice Address - Street 1:2450 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4881
Practice Address - Country:US
Practice Address - Phone:478-445-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2366842084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry