Basic Information
| Provider Information | |||||||||
| NPI: | 1033401328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPARD | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 SOUTH 65 HIGHWAY, BUILDING A | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653403702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608866677 | ||||||||
| FaxNumber: | 6608313346 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 SOUTH 65 HIGHWAY, BUILDING A | ||||||||
| Address2: | MARSHALL WOMEN'S CENTER | ||||||||
| City: | MARSHALL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653403702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608867800 | ||||||||
| FaxNumber: | 6608313346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2003016308 | MO | N | Nursing Service Providers | Registered Nurse | 367A00000X | 2010021104 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1033401328 | 05 | MO | MEDICAID |