Provider Demographics
NPI:1821763384
Name:SHEPARD, LEIGHA (NP)
Entity Type:Individual
Prefix:
First Name:LEIGHA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 POINTE NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1514
Mailing Address - Country:US
Mailing Address - Phone:229-435-7161
Mailing Address - Fax:229-999-6884
Practice Address - Street 1:605 POINTE NORTH BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1514
Practice Address - Country:US
Practice Address - Phone:229-435-7161
Practice Address - Fax:229-999-6884
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner