Healthcare Provider Details

I. General information

NPI: 1114844925
Provider Name (Legal Business Name): KIRSTEN SHEPPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 UPPER GILCHRIST RD
MOUNT VERNON OH
43050-9084
US

IV. Provider business mailing address

4946 STATE ROUTE 229
MARENGO OH
43334-9634
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-2200
  • Fax:
Mailing address:
  • Phone: 614-935-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.458948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: