Provider Demographics
NPI:1912401316
Name:KAEPPLER, MARY SUZANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:KAEPPLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-9163
Mailing Address - Country:US
Mailing Address - Phone:319-400-8144
Mailing Address - Fax:
Practice Address - Street 1:129 JAMES CIR
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-9163
Practice Address - Country:US
Practice Address - Phone:319-400-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily