Provider Demographics
NPI:1366807711
Name:EPPS, MARY REBECCA (PNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:REBECCA
Last Name:EPPS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1359 OLD WATER WORKS RD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3347
Mailing Address - Country:US
Mailing Address - Phone:256-997-5900
Mailing Address - Fax:256-997-5995
Practice Address - Street 1:1359 OLD WATER WORKS RD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3347
Practice Address - Country:US
Practice Address - Phone:256-997-5900
Practice Address - Fax:888-977-1691
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136901363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL185041Medicaid
AL1383376Medicaid
AL184800Medicaid
AL183372Medicaid