Provider Demographics
NPI:1033401328
Name:SHEPARD, MEGAN LEIGH (CNM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-6677
Mailing Address - Fax:660-831-3346
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Practice Address - Street 2:MARSHALL WOMEN'S CENTER
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3346
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016308163W00000X
MO2010021104367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033401328Medicaid
MOH62000002Medicare PIN
MO1033401328Medicaid