Provider Demographics
NPI:1326072620
Name:SHEPHERD, BRENDA K (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1867 CRANE RIDGE DRIVE, SUITE 150-A
Mailing Address - Street 2:UNIVERSITY INTERNAL MEDICINE ASSOCIATES, LLP
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4982
Mailing Address - Country:US
Mailing Address - Phone:601-984-6850
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE/DIVISION OF HYPERTENSION
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR748207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00406254Medicaid
MSQ33494Medicare UPIN