Provider Demographics
NPI:1043034838
Name:JEPSON, JOSIE CATHRYN (PA)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:CATHRYN
Last Name:JEPSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17026 W PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TRIVOLI
Mailing Address - State:IL
Mailing Address - Zip Code:61569-9547
Mailing Address - Country:US
Mailing Address - Phone:309-397-3337
Mailing Address - Fax:
Practice Address - Street 1:1310 N MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3105
Practice Address - Country:US
Practice Address - Phone:309-308-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.010795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant