Provider Demographics
NPI:1962245530
Name:SHEPARD, JESSICA (BSN, RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 INGRAM LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2546
Mailing Address - Country:US
Mailing Address - Phone:478-697-7056
Mailing Address - Fax:
Practice Address - Street 1:235 PARKS MEMORIAL BUILDING
Practice Address - Street 2:CBX 063
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-445-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN312918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse