Provider Demographics
NPI:1366503336
Name:SHEPHERD, JENNIFER E (RNC CPNP IBCLC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:E
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RNC CPNP IBCLC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:EULA MAE
Other - Last Name:JONES-SHEPHERD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNC,CPNP IBCLC
Mailing Address - Street 1:2704 LAVIGNE COURT
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1572
Mailing Address - Country:US
Mailing Address - Phone:254-768-9520
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL ROAD
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525796363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics