MEDICARE: BRANDY SHEPHARD FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F0716562	TN

General Provider Information

NPI Number	:	1073965141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY SHEPHARD FNP

Provider Business Mailing Address
First Line	:	3238 PLAYERS CLUB CIRCLE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125
Country	:	US
Telephone Number	:	901-869-5744
Fax Number	:	901-794-4128

Provider Business Practice Location Address
First Line	:	3238 PLAYERS CLUB CIR STE 58&59
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8843
Country	:	US
Telephone Number	:	901-869-5744
Fax Number	:	901-794-4128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	03/19/2024

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