Provider Demographics
NPI:1588438337
Name:SHEPHERD, KARA LOVE (RN)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LOVE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PEARL MOSS LN
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2962
Mailing Address - Country:US
Mailing Address - Phone:478-662-6296
Mailing Address - Fax:
Practice Address - Street 1:1601 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3431
Practice Address - Country:US
Practice Address - Phone:478-922-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN309793163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse