Provider Demographics
NPI:1013522788
Name:SHEPPEARD, CHASITY ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:ANN
Last Name:SHEPPEARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HIGHWAY 1 S STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8354
Mailing Address - Country:US
Mailing Address - Phone:662-335-1103
Mailing Address - Fax:662-335-8746
Practice Address - Street 1:2525 HIGHWAY 1 S STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8354
Practice Address - Country:US
Practice Address - Phone:623-351-1103
Practice Address - Fax:662-335-8746
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904133363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily