Basic Information
| Provider Information | |||||||||
| NPI: | 1316939036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEPLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | AVERY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1446 FERN CREEK DR | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286259376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049782820 | ||||||||
| FaxNumber: | 7048736859 | ||||||||
| Practice Location | |||||||||
| Address1: | 1446 FERN CREEK DR | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286259376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049782820 | ||||||||
| FaxNumber: | 7049736859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27876 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 48525 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8948525 | 05 | NC | MEDICAID |