Provider Demographics
NPI:1982941977
Name:SHEPPARD, MARSHA LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LOUISE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3944
Mailing Address - Country:US
Mailing Address - Phone:972-219-4312
Mailing Address - Fax:972-219-4367
Practice Address - Street 1:200 S MILL ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3944
Practice Address - Country:US
Practice Address - Phone:972-219-4312
Practice Address - Fax:972-219-4367
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00679363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical