1366503336 NPI number — MS. JENNIFER E. SHEPHERD RNC CPNP IBCLC

Table of content: MS. JENNIFER E. SHEPHERD RNC CPNP IBCLC (NPI 1366503336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366503336 NPI number — MS. JENNIFER E. SHEPHERD RNC CPNP IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPHERD
Provider First Name:
JENNIFER
Provider Middle Name:
E.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNC CPNP IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES-SHEPHERD
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
EULA MAE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNC,CPNP IBCLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366503336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2704 LAVIGNE COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-1572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-768-9520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 MEDICAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT CAVAZOS
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:
254-553-1701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

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: 363LP0200X , with the licence number:  525796 , 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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