Provider Demographics
NPI:1750040242
Name:SHEPHERD, RACE R (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:RACE
Middle Name:R
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12490 QUIVIRA RD APT 3524
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 OLATHE FL 5
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8505
Practice Address - Country:US
Practice Address - Phone:913-588-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS86292947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered