MEDICARE: DAVID ALLEN SHEPPARD CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP 9178159	FL
2	367500000X	Certified Registered Nurse Anesthetist	0024127218	VA
3	367500000X	Certified Registered Nurse Anesthetist	AP118498	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G3089	OTHER	FL	FL BLUECROSS & BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124008560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN SHEPPARD CRNA

Provider Business Mailing Address
First Line	:	4901 RAVENSTHORPE DR
Second Line	:
City	:	PARKER
State	:	TX
Zip	:	75002-5547
Country	:	US
Telephone Number	:	972-442-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 HIGHLAND PARK VLG
Second Line	:	SUITE 100765
City	:	DALLAS
State	:	TX
Zip	:	75205-2789
Country	:	US
Telephone Number	:	214-707-0695
Fax Number	:	214-572-7392

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	04/19/2017

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Directions to “ DAVID ALLEN SHEPPARD CRNA” Practice Location

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