Provider Demographics
NPI:1386909513
Name:SHEPHERD, SHARON LYNN (ACNS)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:ACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 KIDWELL DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1787
Mailing Address - Country:US
Mailing Address - Phone:573-761-7176
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:801 KIDWELL DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1787
Practice Address - Country:US
Practice Address - Phone:573-761-7176
Practice Address - Fax:573-761-6947
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012005558364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health