Provider Demographics
NPI:1154195253
Name:SHEPARD, NATHAN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26979 SUMMER WIND DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-6226
Mailing Address - Country:US
Mailing Address - Phone:636-297-4278
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE HILL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435
Practice Address - Country:US
Practice Address - Phone:636-297-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer