Provider Demographics
NPI:1245656164
Name:SHEPARD, JOCELYN (FNP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARYLAND PLZ FL 3
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1556
Mailing Address - Country:US
Mailing Address - Phone:314-720-1644
Mailing Address - Fax:
Practice Address - Street 1:30 MARYLAND PLZ FL 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1556
Practice Address - Country:US
Practice Address - Phone:314-720-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily