Provider Demographics
NPI:1316415706
Name:SHEPHERD, SHEILA M (FNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:ANN
Other - Last Name:MATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:404 BEMBERG RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2938
Practice Address - Country:US
Practice Address - Phone:423-543-6066
Practice Address - Fax:423-431-2983
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177476363LF0000X
TN24661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24661OtherSTATE LICENSE