Basic Information
| Provider Information | |||||||||
| NPI: | 1225297583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 MAIN ST S | ||||||||
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| City: | MC KEE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404477089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062877104 | ||||||||
| FaxNumber: | 6062874409 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 STACY LANE RD | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403367356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067230665 | ||||||||
| FaxNumber: | 6067230680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 05/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1104193 | KY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 46061 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.