Provider Demographics
NPI:1689303745
Name:EPPERSON, KAYLEE R
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:R
Last Name:EPPERSON
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 1:10144 MENAUL BLVD NE APT P22
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2351
Mailing Address - Country:US
Mailing Address - Phone:804-931-7489
Mailing Address - Fax:
Practice Address - Street 1:7920 WYOMING BLVD NE STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6020
Practice Address - Country:US
Practice Address - Phone:505-420-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician