Provider Demographics
NPI:1700185394
Name:KEPPLE, SHEILA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:KEPPLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:MARIE
Other - Last Name:COYAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-741-3340
Mailing Address - Fax:540-741-3348
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-3340
Practice Address - Fax:540-741-3348
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant