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General NPI Number Information
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NPI Number | 1003225566
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Entity Type | Individual
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Provider Name | LEONARD SHEPHERD M.S.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2014
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 6216 S LEWIS AVE STE 180
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City | TULSA
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State | OK
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Zip | 74136-1077
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Country | US
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Telephone | 918-812-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 ROGERS AVE STE 20
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City | FORT SMITH
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State | AR
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Zip | 72903-3152
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Country | US
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Telephone | 479-276-8871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L046364
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703084481
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License Number State | MI
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