Provider Demographics
NPI:1699335281
Name:SHEPHERD, JENNA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25230 KINGSLAND BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3256
Mailing Address - Country:US
Mailing Address - Phone:281-869-3009
Mailing Address - Fax:
Practice Address - Street 1:25230 KINGSLAND BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3256
Practice Address - Country:US
Practice Address - Phone:281-869-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX862545163WG0000X
TXAP143197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice