Healthcare Provider Details

I. General information

NPI: 1326072620
Provider Name (Legal Business Name): BRENDA K SHEPHERD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET DEPARTMENT OF MEDICINE/DIVISION OF HYPERTENSION
JACKSON MS
39216-4500
US

IV. Provider business mailing address

917 MOUNT ELAM CHURCH RD
PEARL MS
39208-9184
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR748207
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number748207
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number748207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: