Provider Demographics
NPI:1295252575
Name:EPPERSON, TAMARA LEE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 NE 601
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1839
Mailing Address - Country:US
Mailing Address - Phone:660-624-1935
Mailing Address - Fax:
Practice Address - Street 1:471 NE 601
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336-1839
Practice Address - Country:US
Practice Address - Phone:660-624-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013042457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO$$$$$$$$$OtherAETNA
MO$$$$$$$$$OtherBLUE CROSS BLUE SHIELD
MO$$$$$$$$$OtherCOVENTRY
MO$$$$$$$$$OtherTRICARE
MO$$$$$$$$$OtherHUMANA
MO$$$$$$$$$Medicaid