Healthcare Provider Details

I. General information

NPI: 1205088879
Provider Name (Legal Business Name): DEBORAH MARIE SHEPHERD ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH MARIE SHEPHERD ACNP

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E SAHUARO DR
PHOENIX AZ
85028-3112
US

IV. Provider business mailing address

2360 E SAHUARO DR
PHOENIX AZ
85028-3112
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-6744
  • Fax: 472-202-6420
Mailing address:
  • Phone: 928-606-6744
  • Fax: 472-202-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP3149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: