Provider Demographics
NPI:1356513667
Name:EPPERSON, JENNIFER LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CUSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2100 SILVA LN STE B
Mailing Address - Street 2:SUITE I
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3600
Mailing Address - Country:US
Mailing Address - Phone:660-263-6223
Mailing Address - Fax:660-263-6224
Practice Address - Street 1:2100 SILVA LN
Practice Address - Street 2:SUITE B
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3600
Practice Address - Country:US
Practice Address - Phone:660-263-6223
Practice Address - Fax:660-263-6224
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist