Basic Information
| Provider Information | |||||||||
| NPI: | 1336405570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPPARD | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BURCHETT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURCHETT | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | ELISE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2195 HARRODSBURG RD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236371 | ||||||||
| FaxNumber: | 8592577231 | ||||||||
| Practice Location | |||||||||
| Address1: | 2195 HARRODSBURG RD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593236371 | ||||||||
| FaxNumber: | 8592577231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48338 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.