Provider Demographics
NPI:1629561493
Name:SHEPHERD, PATRICK GORMAN (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GORMAN
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:1900 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-4119
Practice Address - Country:US
Practice Address - Phone:606-376-5391
Practice Address - Fax:888-960-2041
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3012643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100562830Medicaid