Provider Demographics
NPI:1013016500
Name:SHEPHERD, KRISTIN SUE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SUE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2118
Mailing Address - Country:US
Mailing Address - Phone:623-878-2800
Mailing Address - Fax:623-878-9150
Practice Address - Street 1:7757 W. DEER VALLEY ROAD SUITE 275
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-878-2800
Practice Address - Fax:623-878-9150
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30054208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics