Provider Demographics
NPI:1518930098
Name:SHEPHERD, CLARICIA SIMMONS (MD)
Entity type:Individual
Prefix:
First Name:CLARICIA
Middle Name:SIMMONS
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:702-383-1961
Mailing Address - Fax:702-319-6147
Practice Address - Street 1:1799 MOUNT MARIAH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1501
Practice Address - Country:US
Practice Address - Phone:702-383-1961
Practice Address - Fax:702-319-6147
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10349208000000X
CAA78787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1518930098Medicaid
NV003102793Medicaid
NV002018793Medicaid
H75378Medicare UPIN
NV003102793Medicaid