Healthcare Provider Details

I. General information

NPI: 1346930385
Provider Name (Legal Business Name): SHEPARD HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAINT ANDREWS RD STE 215B
COLUMBIA SC
29210-4500
US

IV. Provider business mailing address

752 DEERWOOD CROSSING DR
COLUMBIA SC
29229-8244
US

V. Phone/Fax

Practice location:
  • Phone: 803-290-6357
  • Fax:
Mailing address:
  • Phone: 803-290-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE SHEPARD
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 803-290-6357