Provider Demographics
NPI:1437741311
Name:SHEPHERD, BENJAMIN J (APRN)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8025
Mailing Address - Country:US
Mailing Address - Phone:469-833-3774
Mailing Address - Fax:469-202-0268
Practice Address - Street 1:515 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8025
Practice Address - Country:US
Practice Address - Phone:469-833-3774
Practice Address - Fax:469-202-0268
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner