Provider Demographics
NPI:1881157345
Name:SHEPHERD, NAKIESHA LAKAEL (AG-ACNP-BC)
Entity type:Individual
Prefix:DR
First Name:NAKIESHA
Middle Name:LAKAEL
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 TORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2357
Mailing Address - Country:US
Mailing Address - Phone:205-447-1204
Mailing Address - Fax:
Practice Address - Street 1:1641 TORRINGTON DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2357
Practice Address - Country:US
Practice Address - Phone:205-447-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25606363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care