Basic Information
| Provider Information | |||||||||
| NPI: | 1174249106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPARD | ||||||||
| FirstName: | JERA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3127 SOUTHWEST DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724048404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 4793160372 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 E RACE AVE | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 4793160372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R091206 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.