Provider Demographics
NPI:1740284447
Name:SHEPHERD, JANE KANA (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:KANA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1959
Mailing Address - Country:US
Mailing Address - Phone:512-342-0455
Mailing Address - Fax:512-342-0460
Practice Address - Street 1:600 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-1959
Practice Address - Country:US
Practice Address - Phone:512-342-0455
Practice Address - Fax:512-342-0460
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136606413Medicaid
TXD69081Medicare UPIN
TX136606413Medicaid