Provider Demographics
NPI:1225891310
Name:SHEPHERD, RACHEL OLIVIA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:OLIVIA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-8626
Mailing Address - Country:US
Mailing Address - Phone:336-984-1227
Mailing Address - Fax:
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-651-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant