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1750938445 NPI number — KELLY ANN SHEPHERD

NPI Number: 1750938445
Health Care Provider/Practitioner: KELLY ANN SHEPHERD

Information about “1750938445” NPI (KELLY ANN SHEPHERD) exists in 1750938445 in HTML format HTML  |  1750938445 in plain Text format TXT  |  1750938445 in PDF (Portable Document Format) PDF  |  1750938445 in an XML format XML  formats.

NPI Number : 1750938445 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750938445",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHEPHERD",
    "FirstName": "KELLY",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BAILEY",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1200 CORPORATE DR STE 400",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOOVER",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "35242-5424",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-238-7217",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "222 22ND AVE N STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NASHVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37203-1852",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-483-5378",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/19/2019",
    "LastUpdateDate": "01/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "0119-008284",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "6339",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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