Provider Demographics
NPI:1558915264
Name:SHEPHERD, DEBRA ANN (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1744
Mailing Address - Country:US
Mailing Address - Phone:706-766-9076
Mailing Address - Fax:
Practice Address - Street 1:501 MIZE ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-3346
Practice Address - Country:US
Practice Address - Phone:706-638-5580
Practice Address - Fax:706-639-2071
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse