Healthcare Provider Details

I. General information

NPI: 1912410713
Provider Name (Legal Business Name): KATHRYN LYNN SHEPLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BRANDON AVE
CHARLOTTESVILLE VA
22903-3310
US

IV. Provider business mailing address

143 MIMOSA CT
CHARLOTTESVILLE VA
22903-2986
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-3915
  • Fax:
Mailing address:
  • Phone: 860-377-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024175201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: