Provider Demographics
NPI:1780801068
Name:SHEPPEARD, MEGHANN C (MSN, FNP, BC)
Entity type:Individual
Prefix:
First Name:MEGHANN
Middle Name:C
Last Name:SHEPPEARD
Suffix:
Gender:F
Credentials:MSN, FNP, BC
Other - Prefix:
Other - First Name:MEGANN
Other - Middle Name:C
Other - Last Name:FAILS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP, BC
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:MINOR CARE CLINIC
Practice Address - Street 2:6071 U S HWY 49, SUITE 205
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-0000
Practice Address - Country:US
Practice Address - Phone:601-450-3030
Practice Address - Fax:601-450-3031
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily