Provider Demographics
NPI:1124877840
Name:KEPLIN, KEVIN ALFRED
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALFRED
Last Name:KEPLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:ALFRED
Other - Last Name:KEPLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-1799
Mailing Address - Country:US
Mailing Address - Phone:701-550-0181
Mailing Address - Fax:
Practice Address - Street 1:4545 BIA ROAD 12
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-550-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty