Provider Demographics
NPI:1386026110
Name:SHEPHERD, CANDICE MORGAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:MORGAN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MORGAN
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7527 COLLEGE STATION DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1386
Mailing Address - Country:US
Mailing Address - Phone:606-539-4550
Mailing Address - Fax:
Practice Address - Street 1:7527 COLLEGE STATION DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1386
Practice Address - Country:US
Practice Address - Phone:606-539-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant