Provider Demographics
NPI:1437625449
Name:SHEPARD, DIEDRE (FNP-BC)
Entity type:Individual
Prefix:
First Name:DIEDRE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N HIGHWAY 377 STE 110
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-3765
Mailing Address - Country:US
Mailing Address - Phone:940-686-0860
Mailing Address - Fax:
Practice Address - Street 1:3827 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5089
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139187363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP139187OtherAPRN LICENSE