Provider Demographics
NPI:1568059681
Name:SHEPPARD, CHELSY JOY (MSN, FNP, ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHELSY
Middle Name:JOY
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MSN, FNP, ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2424
Mailing Address - Country:US
Mailing Address - Phone:208-750-7464
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:307 SAINT JOHNS WAY STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-743-3998
Practice Address - Fax:208-746-4879
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61126663363L00000X
IDCNR-67916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner