Provider Demographics
NPI:1548532401
Name:SHEPHERD, MARION L (APRN)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:L
Last Name:SHEPHERD
Suffix:
Gender:F
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:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-435-7643
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:101 TOWN AND COUNTRY LN STE 100
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9524
Practice Address - Country:US
Practice Address - Phone:606-433-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007171363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100196890Medicaid
KYP01239891Medicare PIN
KYK045171Medicare PIN