Provider Demographics
NPI:1134405558
Name:SHEPHERD, JOSHUA WAYNE (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:WAYNE
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:165 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8202
Mailing Address - Country:US
Mailing Address - Phone:423-869-7193
Mailing Address - Fax:423-869-7195
Practice Address - Street 1:165 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8202
Practice Address - Country:US
Practice Address - Phone:423-869-7193
Practice Address - Fax:423-869-7195
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical