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General NPI Number Information
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NPI Number | 1770235517
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Entity Type | Individual
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Provider Name | CORINNA JO SHEPPARD MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 868 MORTIMER ST
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City | BARRY
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State | IL
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Zip | 62312-1249
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Country | US
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Telephone | 217-335-2343
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Fax | 217-335-2443
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Provider Business Mailing Address
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Address Line | 1025 MAINE ST
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City | QUINCY
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State | IL
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Zip | 62301-4096
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Country | US
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Telephone | 217-222-6550
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Fax | 217-277-2253
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022004358
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209031361
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2014021972
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License Number State | MO
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