Provider Demographics
NPI:1407360084
Name:SHEPPARD, BRANDI LYNN (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LYNN
Other - Last Name:KOPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2102
Mailing Address - Country:US
Mailing Address - Phone:478-633-6272
Mailing Address - Fax:478-633-6269
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-6272
Practice Address - Fax:478-633-6269
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219759363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine