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General NPI Number Information
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NPI Number | 1528206125
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Entity Type | Individual
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Provider Name | LAURIE SHEPPARD R.P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 262 LEROY GEORGE DR STE X
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City | CLYDE
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State | NC
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Zip | 28721-7430
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Country | US
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Telephone | 828-452-8991
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Fax | 828-452-8338
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Provider Business Mailing Address
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Address Line | 262 LEROY GEORGE DR STE X
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City | CLYDE
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State | NC
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Zip | 28721-7430
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Country | US
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Telephone | 828-452-8991
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Fax | 828-452-8338
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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 | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 03NC1052
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License Number State | NC
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