Provider Demographics
NPI:1780396549
Name:SHEPHERD FAMILY CLINIC, LLC
Entity type:Organization
Organization Name:SHEPHERD FAMILY CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:318-599-3050
Mailing Address - Street 1:1326 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-9113
Mailing Address - Country:US
Mailing Address - Phone:318-599-3050
Mailing Address - Fax:318-599-3051
Practice Address - Street 1:1326 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:LA
Practice Address - Zip Code:71225-9113
Practice Address - Country:US
Practice Address - Phone:318-669-0137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty