Provider Demographics
NPI:1013159029
Name:THOMES PEPIN, JESSICA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:THOMES PEPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 LAKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1709
Mailing Address - Country:US
Mailing Address - Phone:651-735-7414
Mailing Address - Fax:651-735-1827
Practice Address - Street 1:6025 LAKE RD STE 110
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-735-7414
Practice Address - Fax:651-735-1827
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61218207V00000X, 207VX0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program