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General NPI Number Information
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NPI Number | 1861069429
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Entity Type | Individual
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Provider Name | KRISTA MICHELE SHEPHERD RN
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Gender | Female
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 119 E SANDERS LN
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-7557
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Country | US
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Telephone | 502-251-3821
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Fax | 502-251-3822
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Provider Business Mailing Address
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Address Line | 431 WEBB LN
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City | TAYLORSVILLE
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State | KY
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Zip | 40071-6796
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Country | US
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Telephone | 502-321-2449
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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 | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number | 1129569
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License Number State | KY
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