Provider Demographics
NPI:1528830098
Name:KEPLEY, SARA GRACE
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:GRACE
Last Name:KEPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:GRACE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3513 HUNTERS RDG
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-9197
Mailing Address - Country:US
Mailing Address - Phone:731-434-4424
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-789-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73294183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician