=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548982465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAZEL SHEPPARD PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2022
-----------------------------------------------------
Last Update Date | 02/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3007 E BOUNDARY TER STE 204
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-331-2764
-----------------------------------------------------
Fax | 804-902-8560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3007 E BOUNDARY TER STE 204
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23112-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-333-2764
-----------------------------------------------------
Fax | 804-902-8560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 0024185265
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------