Provider Demographics
NPI:1629327713
Name:CHEPA, JESSICA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:CHEPA
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:843-881-5081
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCAPN.17992.RX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2149Medicaid
SCNP2149Medicaid