Basic Information
| Provider Information | |||||||||
| NPI: | 1609995315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEPNER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD, CDE | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HEPNER | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 740 S LIMESTONE | ||||||||
| Address2: | RM J449 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235404 | ||||||||
| FaxNumber: | 8593238179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2195 HARRODSBURG RD STE 125 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232232 | ||||||||
| FaxNumber: | 8592570659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1924 | KY | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 122859 | KY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.