Provider Demographics
NPI:1508614322
Name:SHEPHERD, RACHEL J
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:J
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 STERMER RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5532
Mailing Address - Country:US
Mailing Address - Phone:501-327-1701
Mailing Address - Fax:
Practice Address - Street 1:3240 STERMER RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5532
Practice Address - Country:US
Practice Address - Phone:501-327-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator