Provider Demographics
NPI:1720485154
Name:SHEPARD, KARISSA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:ANN
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 PINE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-4326
Mailing Address - Country:US
Mailing Address - Phone:423-440-4315
Mailing Address - Fax:
Practice Address - Street 1:403 E G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3223
Practice Address - Country:US
Practice Address - Phone:423-543-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000198695163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health