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NPI Code Detail

MEDICARE: MRS. STACY E SHEPPARD PMHNP

MEDICARE: MRS. STACY E SHEPPARD PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2012016535TN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner64577WV
3363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN64577WV

General Provider Information

NPI Number : 1669725792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY E SHEPPARD PMHNP
Provider Business Mailing Address
First Line : PO BOX 1680
Second Line :
City : HUNTINGTON
State : WV
Zip : 25717-1680
Country : US
Telephone Number : 304-781-5159
Fax Number : 304-523-8115
Provider Business Practice Location Address
First Line : 1 HARBOUR WAY
Second Line :
City : MILTON
State : WV
Zip : 25541-1545
Country : US
Telephone Number : 304-781-5050
Fax Number : 304-781-5051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2012
Last Update Date : 07/16/2024

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