Provider Demographics
NPI:1083901821
Name:SHEPPARD, JOSEPH KIRK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KIRK
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 LA QUESTA DR.
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850
Mailing Address - Country:US
Mailing Address - Phone:417-283-4953
Mailing Address - Fax:417-283-4954
Practice Address - Street 1:4040 LA QUESTA DR.
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850
Practice Address - Country:US
Practice Address - Phone:417-283-4953
Practice Address - Fax:417-283-4954
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine