Provider Demographics
NPI:1891156790
Name:SHEPPARD, GINGER ELAINE (LD)
Entity Type:Individual
Prefix:MS
First Name:GINGER
Middle Name:ELAINE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W MLK JR BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1231
Mailing Address - Country:US
Mailing Address - Phone:512-868-6012
Mailing Address - Fax:512-842-7227
Practice Address - Street 1:710 N 64TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4387
Practice Address - Country:US
Practice Address - Phone:512-686-6012
Practice Address - Fax:512-842-7227
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered