Provider Demographics
NPI:1336738590
Name:SHEPARD, KATHERINE CELESTE (DNAP, CRNA, APRN)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CELESTE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:DNAP, CRNA, APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CELESTE
Other - Last Name:KUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 PEACOCK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7806
Mailing Address - Country:US
Mailing Address - Phone:502-644-8300
Mailing Address - Fax:
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-897-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015699367500000X
KY1144035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse