Provider Demographics
NPI:1023021508
Name:SHEPARD, PAUL M (RN, MSN, APN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:RN, MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 LOVE RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-8631
Mailing Address - Country:US
Mailing Address - Phone:870-356-2434
Mailing Address - Fax:
Practice Address - Street 1:1401 MALVERN AVE
Practice Address - Street 2:ROOM 152
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6327
Practice Address - Country:US
Practice Address - Phone:501-624-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner