Provider Demographics
NPI:1538701222
Name:SHEPHERD-HEBB, BETTY JO
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JO
Last Name:SHEPHERD-HEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:JO
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4110 DEBARR RD SPC G17
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3176
Mailing Address - Country:US
Mailing Address - Phone:907-202-4684
Mailing Address - Fax:
Practice Address - Street 1:4110 DEBARR RD SPC G17
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3176
Practice Address - Country:US
Practice Address - Phone:907-202-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist