Provider Demographics
NPI:1699759118
Name:EPPLE, KEVIN DAVID (PAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:EPPLE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2733
Mailing Address - Country:US
Mailing Address - Phone:972-745-4446
Mailing Address - Fax:972-745-2597
Practice Address - Street 1:670 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2733
Practice Address - Country:US
Practice Address - Phone:972-745-4446
Practice Address - Fax:972-745-2597
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06218363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L21157Medicare PIN