Provider Demographics
NPI:1346887403
Name:SHEPHERD, TEMETHA
Entity Type:Individual
Prefix:
First Name:TEMETHA
Middle Name:
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 1:6608 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-5014
Mailing Address - Country:US
Mailing Address - Phone:318-272-0872
Mailing Address - Fax:318-779-1731
Practice Address - Street 1:6608 VENUS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-5014
Practice Address - Country:US
Practice Address - Phone:318-272-0872
Practice Address - Fax:318-779-1731
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
LA007425408343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)