Provider Demographics
NPI:1821976390
Name:KEPPLE, KAITLYN (LMSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:KEPPLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 CARBON DR
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-1084
Mailing Address - Country:US
Mailing Address - Phone:502-640-3296
Mailing Address - Fax:
Practice Address - Street 1:2109 CARBON DR
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-1084
Practice Address - Country:US
Practice Address - Phone:502-640-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109415104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker