Provider Demographics
NPI:1336405570
Name:SHEPPARD, MARY BURCHETT (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BURCHETT
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELISE
Other - Last Name:BURCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2195 HARRODSBURG RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3504
Mailing Address - Country:US
Mailing Address - Phone:859-323-6371
Mailing Address - Fax:859-257-7231
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-323-6371
Practice Address - Fax:859-257-7231
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine