Individual
MS. SUSAN LARYSSA EPPERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
289 IRELAND AVE, MEDDAC BLDG 851 RM N1A-53, FORT KNOX, KY 40121-5111
(502) 624-0250
(502) 624-0443
Mailing address
289 IRELAND AVE, MEDDAC BLDG 851 RM N1A-53, FORT KNOX, KY 40121-5111
(502) 624-0250
(502) 624-0443
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA175
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1024552
NCCPA CERTIFICATE NUMBER
—
01
—
PA175
KENTUCKY CERTIFICATION
KY
Enumeration date
11/16/2005
Last updated
09/23/2008
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