Provider Demographics
NPI:1104142256
Name:SHEPARD, CATHLEEN ANNE (RRT, AE-C)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ANNE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RRT, AE-C
Other - Prefix:MS
Other - First Name:CATHLEEN
Other - Middle Name:ANNE
Other - Last Name:KIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1506
Mailing Address - Country:US
Mailing Address - Phone:662-615-3111
Mailing Address - Fax:662-615-3115
Practice Address - Street 1:400 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2163
Practice Address - Country:US
Practice Address - Phone:662-615-3111
Practice Address - Fax:662-615-3115
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRCP3308227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered