Provider Demographics
NPI:1710321831
Name:SHEPHERD, KAYLEE JANE (MD)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JANE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S COULTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1769
Mailing Address - Country:US
Mailing Address - Phone:806-358-8331
Mailing Address - Fax:806-355-0045
Practice Address - Street 1:1215 S COULTER ST STE 101
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1761
Practice Address - Country:US
Practice Address - Phone:806-358-8331
Practice Address - Fax:806-356-0045
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3799207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200717790AMedicaid
NM19600526Medicaid
TX357544104Medicaid
TX357544103Medicaid