Healthcare Provider Details

I. General information

NPI: 1326684036
Provider Name (Legal Business Name): JULIE LYNN SHEPHERD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIR STE 302A
NORFOLK VA
23502-3936
US

IV. Provider business mailing address

2853 BALD EAGLE RD
VIRGINIA BEACH VA
23453-7061
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-9288
  • Fax: 757-457-3691
Mailing address:
  • Phone: 757-237-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: