Provider Demographics
NPI:1447412572
Name:SHEPHERD, ANNA WHITAKER (DI)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:WHITAKER
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:WHITAKER
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:488 E DORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-9011
Mailing Address - Country:US
Mailing Address - Phone:606-297-5625
Mailing Address - Fax:606-297-5625
Practice Address - Street 1:488 E DORTON BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41256-9011
Practice Address - Country:US
Practice Address - Phone:606-297-5625
Practice Address - Fax:606-297-5625
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist