Basic Information
Provider Information
NPI: 1790296648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEPPERT
FirstName: ASHLEY
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: APRN-CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5074
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571175074
CountryCode: US
TelephoneNumber: 6053286585
FaxNumber: 6053289802
Practice Location
Address1: 1600 W 22ND ST
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571051521
CountryCode: US
TelephoneNumber: 6053121000
FaxNumber: 6053121001
Other Information
ProviderEnumerationDate: 10/18/2017
LastUpdateDate: 12/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LN0000XCP001296SDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal

No ID Information.


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