Provider Demographics
NPI:1821412255
Name:PEPPERMAN, SCOTT (RD, LD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:PEPPERMAN
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 N CAMPUS DR
Mailing Address - Street 2:APT 1
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3615
Mailing Address - Country:US
Mailing Address - Phone:315-729-6893
Mailing Address - Fax:
Practice Address - Street 1:401 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5679
Practice Address - Country:US
Practice Address - Phone:620-272-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered