Provider Demographics
NPI:1528206125
Name:SHEPPARD, LAURIE (RPA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 LEROY GEORGE DR STE X
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7430
Mailing Address - Country:US
Mailing Address - Phone:828-452-8991
Mailing Address - Fax:828-452-8338
Practice Address - Street 1:262 LEROY GEORGE DR STE X
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-452-8991
Practice Address - Fax:828-452-8338
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03NC1052243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant