Provider Demographics
NPI:1083944011
Name:SHEPHERD-WHISENANT, KATRINA NICOLE (DI)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:NICOLE
Last Name:SHEPHERD-WHISENANT
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7774
Mailing Address - Country:US
Mailing Address - Phone:606-634-3065
Mailing Address - Fax:
Practice Address - Street 1:84 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7774
Practice Address - Country:US
Practice Address - Phone:606-634-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency