Basic Information
Provider Information
NPI: 1477945939
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEPLEY
FirstName: JOHN
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3735 GLENLAKE DR STE 250
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282086866
CountryCode: US
TelephoneNumber: 7047495800
FaxNumber: 7046263237
Practice Location
Address1: 2460 CURTIS ELLIS DR
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278042237
CountryCode: US
TelephoneNumber: 7047495800
FaxNumber: 7046263237
Other Information
ProviderEnumerationDate: 02/20/2015
LastUpdateDate: 10/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X0102204729VAN Allopathic & Osteopathic PhysiciansGeneral Practice 
207L00000X02268NCY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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