Provider Demographics
NPI:1376589135
Name:SHEPHERD, KAREN (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CHERRY ST.
Mailing Address - Street 2:P.O.BOX 1027
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327
Mailing Address - Country:US
Mailing Address - Phone:423-949-5091
Mailing Address - Fax:423-949-4231
Practice Address - Street 1:170 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327
Practice Address - Country:US
Practice Address - Phone:423-949-5091
Practice Address - Fax:423-949-4231
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO00000481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051903OtherBCBS OF TENNESSEE
TN3301985Medicaid
TNP00290039OtherRAILROAD MEDICARE
TN3301985Medicaid
TN3301980Medicare PIN