Basic Information
| Provider Information | |||||||||
| NPI: | 1417251844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EPPERSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 HOSPITAL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241121929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766344976 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4601 WHITESBURG DR SE STE 201 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568801050 | ||||||||
| FaxNumber: | 2562134681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2010 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-149092 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 0024169255 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 529901250 | 05 | AL | MEDICAID |