Provider Demographics
NPI:1861741159
Name:KLOEPFER, BEVERLY ALANE (NP-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ALANE
Last Name:KLOEPFER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-9687
Mailing Address - Country:US
Mailing Address - Phone:208-746-4115
Mailing Address - Fax:
Practice Address - Street 1:4087 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-9687
Practice Address - Country:US
Practice Address - Phone:208-746-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1212A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily