Provider Demographics
NPI:1962912493
Name:EPPS, KATERRIA NICOLLETTE PHYLEECE
Entity type:Individual
Prefix:
First Name:KATERRIA
Middle Name:NICOLLETTE PHYLEECE
Last Name:EPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 E PRICE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-1498
Mailing Address - Country:US
Mailing Address - Phone:903-278-3471
Mailing Address - Fax:
Practice Address - Street 1:1675 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2219
Practice Address - Country:US
Practice Address - Phone:903-782-9922
Practice Address - Fax:903-784-8384
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT70052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer