Provider Demographics
NPI:1174083281
Name:SHEPHERD, TAMMY SUE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RESCH ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-2036
Mailing Address - Country:US
Mailing Address - Phone:419-673-5640
Mailing Address - Fax:
Practice Address - Street 1:34 RESCH ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2036
Practice Address - Country:US
Practice Address - Phone:419-673-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2018070343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily