Provider Demographics
NPI:1215021258
Name:SHEPPARD, CHRISTINA (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2920 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1943
Practice Address - Country:US
Practice Address - Phone:606-408-7337
Practice Address - Fax:606-326-9596
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4638P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2693116Medicaid
KY78017175Medicaid
KY3400342Medicare PIN
KY0264265Medicare PIN
Q60430Medicare UPIN
KY0307659Medicare PIN
KY78017175Medicaid
KY0351457Medicare PIN
KY0586630Medicare PIN