Provider Demographics
NPI:1285993519
Name:EPPERLY, ALEXANDER RYAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:RYAN
Last Name:EPPERLY
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:4815 KANAWHA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1207
Mailing Address - Country:US
Mailing Address - Phone:304-768-4567
Mailing Address - Fax:
Practice Address - Street 1:4815 KANAWHA AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1207
Practice Address - Country:US
Practice Address - Phone:304-768-4567
Practice Address - Fax:304-768-2277
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012054Medicaid
WVWV2881AMedicare PIN