Provider Demographics
NPI:1023384807
Name:SHEPARD, RAKIA (LPN)
Entity Type:Individual
Prefix:
First Name:RAKIA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 BRIAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5690
Mailing Address - Country:US
Mailing Address - Phone:404-374-5206
Mailing Address - Fax:
Practice Address - Street 1:3003 BRIAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5690
Practice Address - Country:US
Practice Address - Phone:404-374-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140435164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse