Provider Demographics
NPI:1073865499
Name:SHEARD, BRODERICK ALLEN (C-NP)
Entity Type:Individual
Prefix:MR
First Name:BRODERICK
Middle Name:ALLEN
Last Name:SHEARD
Suffix:
Gender:M
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5672
Mailing Address - Country:US
Mailing Address - Phone:620-272-2222
Mailing Address - Fax:
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-275-3030
Practice Address - Fax:620-275-3025
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0006904111N00000X
KS53-80285-061363LF0000X
KS80285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor