Provider Demographics
NPI:1013253079
Name:SHEPHERD, KRISTINA (CNM)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAURISTON ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3631
Mailing Address - Country:US
Mailing Address - Phone:508-369-9464
Mailing Address - Fax:
Practice Address - Street 1:1019 IYANNOUGH RD STE 100
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1839
Practice Address - Country:US
Practice Address - Phone:508-771-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2274823367A00000X
RI00141367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife