Provider Demographics
NPI:1144748898
Name:SHEPARD, CASSANDRA LATASHA (FNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LATASHA
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-9723
Mailing Address - Country:US
Mailing Address - Phone:662-721-8036
Mailing Address - Fax:
Practice Address - Street 1:140 NORTH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2744
Practice Address - Country:US
Practice Address - Phone:662-545-4674
Practice Address - Fax:662-545-4715
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner