Provider Demographics
NPI:1578694378
Name:SHEPARD, THOMAS AKERS (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:AKERS
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 OUTLOOK BLVD
Mailing Address - Street 2:SUITE 37
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1667
Mailing Address - Country:US
Mailing Address - Phone:719-562-6300
Mailing Address - Fax:719-562-6375
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:SUITE 37
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-562-6300
Practice Address - Fax:719-562-6375
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant