Provider Demographics
NPI:1174103618
Name:SHEPHERD, STEFANIE (PMHNP, APRN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:
Credentials:PMHNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SHUN PIKE
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1733
Mailing Address - Country:US
Mailing Address - Phone:859-396-2051
Mailing Address - Fax:
Practice Address - Street 1:989 GOVERNORS LN STE 140
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1174
Practice Address - Country:US
Practice Address - Phone:859-494-9984
Practice Address - Fax:833-973-4422
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039000363LP0808X
KY3016030363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health