Healthcare Provider Details

I. General information

NPI: 1326535816
Provider Name (Legal Business Name): KINDRA LEE SHEPARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N 6TH ST
TERRE HAUTE IN
47807-1019
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3109
  • Fax: 812-242-3990
Mailing address:
  • Phone: 812-242-3157
  • Fax: 812-242-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007928A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: