Provider Demographics
NPI:1396733747
Name:KEPNER, COLLEEN S (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:S
Last Name:KEPNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-2545
Mailing Address - Fax:703-776-2917
Practice Address - Street 1:6400 ARLINGTON BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-531-3000
Practice Address - Fax:703-531-3142
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41634207V00000X
VA0101257795207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49788361Medicaid
BK8308187OtherDEA
CO49788361Medicaid
BK8308187OtherDEA