Healthcare Provider Details

I. General information

NPI: 1548982465
Provider Name (Legal Business Name): HAZEL SHEPPARD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 E BOUNDARY TER STE 204
MIDLOTHIAN VA
23112-3933
US

IV. Provider business mailing address

3007 E BOUNDARY TER STE 204
MIDLOTHIAN VA
23112-3933
US

V. Phone/Fax

Practice location:
  • Phone: 804-331-2764
  • Fax: 804-902-8560
Mailing address:
  • Phone: 804-333-2764
  • Fax: 804-902-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: