Provider Demographics
NPI:1598483349
Name:SHEPHARD, REBEKAH ROSEMARY
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:ROSEMARY
Last Name:SHEPHARD
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 1:200 HIGHLAND AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-4712
Mailing Address - Country:US
Mailing Address - Phone:304-777-6604
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHLAND AVE APT A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4712
Practice Address - Country:US
Practice Address - Phone:304-777-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program