Provider Demographics
NPI:1215311527
Name:SHEPARD, CLINT (PA-C)
Entity type:Individual
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First Name:CLINT
Middle Name:
Last Name:SHEPARD
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:20 MEDICAL PARK
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6390
Mailing Address - Country:US
Mailing Address - Phone:304-243-7030
Mailing Address - Fax:304-243-4282
Practice Address - Street 1:20 MEDICAL PARK
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6390
Practice Address - Country:US
Practice Address - Phone:304-243-7030
Practice Address - Fax:304-243-4282
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant