Provider Demographics
NPI:1003412792
Name:SHEPHERD, KIERA DAWN (LMT)
Entity Type:Individual
Prefix:MS
First Name:KIERA
Middle Name:DAWN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W 26TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6399
Mailing Address - Country:US
Mailing Address - Phone:562-533-1073
Mailing Address - Fax:
Practice Address - Street 1:503 W 26TH ST APT 6
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6399
Practice Address - Country:US
Practice Address - Phone:562-533-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist