Provider Demographics
NPI:1164995346
Name:SHEPARD, RACHELLE (APRN, AGNP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:APRN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 DEERWOOD CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8244
Mailing Address - Country:US
Mailing Address - Phone:803-290-6357
Mailing Address - Fax:
Practice Address - Street 1:752 DEERWOOD CROSSING DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8244
Practice Address - Country:US
Practice Address - Phone:803-290-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22445207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine