Provider Demographics
NPI:1528276128
Name:SHEPHERD, JESSICA S (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:717 STATE STREET, SUITE 16 LL
Mailing Address - Street 2:REGIONAL HEALTH SERVICES, INC
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1360
Mailing Address - Country:US
Mailing Address - Phone:814-877-7100
Mailing Address - Fax:814-877-2939
Practice Address - Street 1:2 CRESCENT PARK WEST
Practice Address - Street 2:WARREN EMERGENCY ROOM
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-2510
Practice Address - Fax:814-723-4654
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012810207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009109580001Medicaid
BS8504195OtherFEDERAL DEA
PA1009109580001Medicaid