Provider Demographics
NPI:1376890046
Name:SHEPHERD, CHELSEA TRIPP (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:TRIPP
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E 3RD ST
Mailing Address - Street 2:ST LUKE'S SOUTHSIDE MEDICAL CENTER SPECIAL CARE CLINIC
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2072
Mailing Address - Country:US
Mailing Address - Phone:494-526-2062
Mailing Address - Fax:
Practice Address - Street 1:511 E 3RD ST
Practice Address - Street 2:ST LUKE'S SOUTHSIDE MEDICAL CENTER SPECIAL CARE CLINIC
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2072
Practice Address - Country:US
Practice Address - Phone:494-526-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012120363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health