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NPI Code Detail

MEDICARE: ROBIN BERRY SHEPHERD PMHNP-BC

MEDICARE: ROBIN BERRY SHEPHERD PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP10239AZ

General Provider Information

NPI Number : 1245760420
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN BERRY SHEPHERD PMHNP-BC
Provider Business Mailing Address
First Line : PO BOX 394
Second Line :
City : HIGLEY
State : AZ
Zip : 85236-0394
Country : US
Telephone Number : 480-286-2347
Fax Number :
Provider Business Practice Location Address
First Line : 4330 E UNIVERSITY DR
Second Line :
City : MESA
State : AZ
Zip : 85205-7004
Country : US
Telephone Number : 480-218-3280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2017
Last Update Date : 01/02/2020

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