Provider Demographics
NPI:1598549842
Name:KEPLIN, MADISON RAYE (APRN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAYE
Last Name:KEPLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:RAYE
Other - Last Name:GOURNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0748
Mailing Address - Country:US
Mailing Address - Phone:701-317-1099
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-7712
Practice Address - Country:US
Practice Address - Phone:701-317-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily