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General NPI Number Information
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NPI Number | 1245747005
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Entity Type | Individual
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Provider Name | CARLA SHEPARD APRN, RN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1730 PROSPECT AVE STE 100
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City | KANSAS CITY
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State | MO
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Zip | 64127-2573
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Country | US
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Telephone | 816-946-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 13745 MOHAWK RD APT 1110
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City | LEAWOOD
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State | KS
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Zip | 66224-4672
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Country | US
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Telephone | 717-440-0588
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 53-77990-072
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2017042704
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 53-77990-072
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2017042704
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2017042704
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License Number State | MO
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