Provider Demographics
NPI:1306089271
Name:JEPSON, MARK A (NP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:JEPSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2650 S EAGLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6733
Mailing Address - Country:US
Mailing Address - Phone:986-200-4290
Mailing Address - Fax:986-200-4291
Practice Address - Street 1:2650 S EAGLE RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6733
Practice Address - Country:US
Practice Address - Phone:986-200-4290
Practice Address - Fax:986-200-4291
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-902A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1250802Medicare Oscar/Certification