Provider Demographics
NPI:1770550204
Name:LEPPERT, KATHERINE JOY (APRN, NP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JOY
Last Name:LEPPERT
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:320 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441
Mailing Address - Country:US
Mailing Address - Phone:218-546-7000
Mailing Address - Fax:218-546-4400
Practice Address - Street 1:320 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-546-4400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129784-1363L00000X
MN783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500004256Medicare UPIN