Provider Demographics
NPI:1578065876
Name:SHEPHERD, KATIE MORROW
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MORROW
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 HARRIER PL
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4745
Mailing Address - Country:US
Mailing Address - Phone:614-302-3099
Mailing Address - Fax:
Practice Address - Street 1:7690 NEW MARKET CENTER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1976
Practice Address - Country:US
Practice Address - Phone:614-602-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator