Provider Demographics
NPI:1386108546
Name:SHEPARD, PATRICIA (CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6500
Mailing Address - Country:US
Mailing Address - Phone:575-941-2500
Mailing Address - Fax:575-941-2503
Practice Address - Street 1:402 E WOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6500
Practice Address - Country:US
Practice Address - Phone:575-941-2500
Practice Address - Fax:575-941-2503
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55047363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care