Healthcare Provider Details

I. General information

NPI: 1104549948
Provider Name (Legal Business Name): CORNERSTONE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 S MAIN ST STE D
JOPLIN MO
64804-2678
US

IV. Provider business mailing address

2613 S MAIN ST STE D
JOPLIN MO
64804-2678
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-8730
  • Fax:
Mailing address:
  • Phone: 417-553-7920
  • Fax: 877-464-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH KIRK SHEPPARD
Title or Position: CEO
Credential:
Phone: 417-379-1176