Healthcare Provider Details

I. General information

NPI: 1457988057
Provider Name (Legal Business Name): DARCY L SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 N DETROIT ST
XENIA OH
45385-1960
US

IV. Provider business mailing address

371 XENIA AVE APT 1
DAYTON OH
45410-1536
US

V. Phone/Fax

Practice location:
  • Phone: 937-505-1877
  • Fax: 800-480-7578
Mailing address:
  • Phone: 937-793-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.001581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: