Provider Demographics
NPI:1184939613
Name:HEPNER, JOHANN ROSS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOHANN
Middle Name:ROSS
Last Name:HEPNER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1600
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4407
Mailing Address - Country:US
Mailing Address - Phone:808-432-7600
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4407
Practice Address - Country:US
Practice Address - Phone:808-432-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258601363LP0808X
HIAPRN-2285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088034BMedicaid