1053348995 NPI number — MRS. JENNIFER INEZ SHEPARD LVN

Table of content: MRS. JENNIFER INEZ SHEPARD LVN (NPI 1053348995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053348995 NPI number — MRS. JENNIFER INEZ SHEPARD LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPARD
Provider First Name:
JENNIFER
Provider Middle Name:
INEZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PENA
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
INEZ
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053348995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36000 DARNALL LOOP
Provider Second Line Business Mailing Address:
CARL R DARNALL ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31ST & BATTALION
Provider Second Line Business Practice Location Address:
BENNETT HEALTH CLINIC BDG # 420
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-318-8100
Provider Business Practice Location Address Fax Number:
254-618-8099
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  TX182542 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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