Healthcare Provider Details

I. General information

NPI: 1538083712
Provider Name (Legal Business Name): KAILA SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N FAIR AVE
HAMILTON OH
45011-4222
US

IV. Provider business mailing address

250 N FAIR AVE
HAMILTON OH
45011-4222
US

V. Phone/Fax

Practice location:
  • Phone: 513-887-5035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN143030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: