Provider Demographics
NPI:1306000815
Name:SHEPHERD, CARRIE SUE (AT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:SUE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BULLDOG DR
Mailing Address - Street 2:
Mailing Address - City:PLUMERVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72127-8803
Mailing Address - Country:US
Mailing Address - Phone:501-354-2269
Mailing Address - Fax:501-354-0167
Practice Address - Street 1:1300 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-9403
Practice Address - Country:US
Practice Address - Phone:501-208-5911
Practice Address - Fax:501-208-5912
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206055721Medicaid