Provider Demographics
NPI:1376054742
Name:SHEPHERD, JAYSON DANIEL (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:DANIEL
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-2324
Mailing Address - Country:US
Mailing Address - Phone:660-543-4111
Mailing Address - Fax:660-543-8551
Practice Address - Street 1:116 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2324
Practice Address - Country:US
Practice Address - Phone:660-543-4111
Practice Address - Fax:660-543-8551
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0882452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer