Provider Demographics
NPI:1326684036
Name:SHEPHERD, JULIE LYNN
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
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 1:2853 BALD EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-7061
Mailing Address - Country:US
Mailing Address - Phone:757-237-3388
Mailing Address - Fax:
Practice Address - Street 1:6160 KEMPSVILLE CIR STE 302A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3936
Practice Address - Country:US
Practice Address - Phone:757-466-9288
Practice Address - Fax:757-457-3691
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily