Provider Demographics
NPI:1790355360
Name:EPPERSON, KARA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 EL RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2422
Mailing Address - Country:US
Mailing Address - Phone:530-613-3475
Mailing Address - Fax:
Practice Address - Street 1:335 E AVENUE I
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1916
Practice Address - Country:US
Practice Address - Phone:661-471-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5264363A00000X
390200000X
CA63157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program