Provider Demographics
NPI:1699100727
Name:REPKING, NATALIE L (MS)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:L
Last Name:REPKING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3202 JAMES ROBERT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6517
Mailing Address - Country:US
Mailing Address - Phone:217-343-0963
Mailing Address - Fax:
Practice Address - Street 1:190 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2245
Practice Address - Country:US
Practice Address - Phone:662-298-0066
Practice Address - Fax:662-298-0067
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist