Healthcare Provider Details

I. General information

NPI: 1760690010
Provider Name (Legal Business Name): KRISTEN AMANDA SHEPHERD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 US 70 HWY E
GARNER NC
27529-3982
US

IV. Provider business mailing address

5504 S TURNBERRY RD
ROGERS AR
72758-8220
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-5611
  • Fax:
Mailing address:
  • Phone: 501-519-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024703
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29392
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number219568
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: