Basic Information
| Provider Information | |||||||||
| NPI: | 1831139252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEPNER | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3515 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276124934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197814060 | ||||||||
| FaxNumber: | 9197815246 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 FOREST HILLS DR | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275293690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197814060 | ||||||||
| FaxNumber: | 9198636990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 04/14/2009 | ||||||||
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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 | 225100000X | 10389 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 067WX | 01 | NC | BLUE CROSS BLUE SHIELD OF | OTHER |