Provider Demographics
NPI:1912608571
Name:SHEPHARD'S GERIATRIC CARE
Entity Type:Organization
Organization Name:SHEPHARD'S GERIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:419-320-0657
Mailing Address - Street 1:1850 EASTGATE RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3024
Mailing Address - Country:US
Mailing Address - Phone:567-315-8761
Mailing Address - Fax:
Practice Address - Street 1:1850 EASTGATE RD STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3024
Practice Address - Country:US
Practice Address - Phone:567-315-8761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty