Provider Demographics
NPI:1407510704
Name:SHEPARD, AMANDA S (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:S
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:S
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7200 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4202
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:
Practice Address - Street 1:1317 LAKE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3997
Practice Address - Country:US
Practice Address - Phone:281-637-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904958363LA2100X
TX1056921363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care