Provider Demographics
NPI:1669725792
Name:SHEPPARD, STACY E (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:E
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:E
Other - Last Name:GUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-781-5159
Mailing Address - Fax:304-523-8115
Practice Address - Street 1:1 HARBOUR WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1545
Practice Address - Country:US
Practice Address - Phone:304-781-5050
Practice Address - Fax:304-781-5051
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2012016535363LP0808X
WV64577363LP0808X
WVAPRN64577363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health