Provider Demographics
NPI:1417773870
Name:KEPFER, AMANDA LEIGH (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:KEPFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BEDFORD AVE APT 17F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2606
Mailing Address - Country:US
Mailing Address - Phone:404-429-9919
Mailing Address - Fax:
Practice Address - Street 1:300 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6800
Practice Address - Country:US
Practice Address - Phone:646-888-4662
Practice Address - Fax:646-888-4920
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312018363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health