Provider Demographics
NPI:1952361826
Name:SHEPARD, RACHAEL A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:A
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 N MAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-9670
Mailing Address - Country:US
Mailing Address - Phone:816-591-7319
Mailing Address - Fax:
Practice Address - Street 1:10021 N MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-9670
Practice Address - Country:US
Practice Address - Phone:816-591-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116495367500000X
KS43-557169-051367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO910106400Medicaid
Q63348Medicare UPIN
MO910106400Medicaid
MO452E380Medicare PIN