Provider Demographics
NPI:1447815279
Name:EPPERSON, MADISYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MADISYN
Middle Name:
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PROVINCIAL WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-7504
Mailing Address - Country:US
Mailing Address - Phone:606-425-2122
Mailing Address - Fax:
Practice Address - Street 1:26 OXFORD WAY STE B
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2813
Practice Address - Country:US
Practice Address - Phone:606-425-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant