Provider Demographics
NPI:1710601174
Name:KEPLER, MIRANDA CLARE
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:CLARE
Last Name:KEPLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:CLARE
Other - Last Name:MICKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58147 COLUMBIA RIVER HWY STE C
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6229
Mailing Address - Country:US
Mailing Address - Phone:510-364-7657
Mailing Address - Fax:
Practice Address - Street 1:58147 COLUMBIA RIVER HWY STE C
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6229
Practice Address - Country:US
Practice Address - Phone:510-364-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program