Provider Demographics
NPI:1124008560
Name:SHEPPARD, DAVID ALLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 RAVENSTHORPE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5547
Mailing Address - Country:US
Mailing Address - Phone:972-442-9743
Mailing Address - Fax:
Practice Address - Street 1:25 HIGHLAND PARK VLG
Practice Address - Street 2:SUITE 100765
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2789
Practice Address - Country:US
Practice Address - Phone:214-707-0695
Practice Address - Fax:214-572-7392
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9178159367500000X
VA0024127218367500000X
TXAP118498367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3089OtherFL BLUECROSS & BLUESHIELD
GA00920422AMedicaid
FL304001600Medicaid
GA00920422AMedicaid
VA430040864Medicare PIN