Provider Demographics
NPI:1720460934
Name:KEPPLE, SHARON KAYE-BOOTHE (PHD, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAYE-BOOTHE
Last Name:KEPPLE
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 SAXONY PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-203-3839
Mailing Address - Fax:760-203-3840
Practice Address - Street 1:561 SAXONY PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-203-3839
Practice Address - Fax:760-203-3840
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8383363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner