Healthcare Provider Details

I. General information

NPI: 1972906865
Provider Name (Legal Business Name): TERICA SHEPHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6441 SLACK RD
REYNOLDSBURG OH
43068-2859
US

IV. Provider business mailing address

6441 SLACK RD
REYNOLDSBURG OH
43068-2859
US

V. Phone/Fax

Practice location:
  • Phone: 614-743-9076
  • Fax:
Mailing address:
  • Phone: 614-743-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number376111741296
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: