MEDICARE: DIEDRE SHEPARD FNP-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
1	363L00000X	Nurse Practitioner	APRN-192375	MT
2	363L00000X	Nurse Practitioner	11506	MN
3	363LF0000X	Family Nurse Practitioner	890389	NV
4	363LF0000X	Family Nurse Practitioner	APRN11039824	FL
5	363L00000X	Nurse Practitioner	CAPN0003095CNP	CO
6	363LF0000X	Family Nurse Practitioner	AP70006064	WA
7	363L00000X	Nurse Practitioner	53-82935-102	KS
8	363L00000X	Nurse Practitioner	AP139187	TX
9	363L00000X	Nurse Practitioner	305855	AZ
10	363L00000X	Nurse Practitioner	5014718	NC
11	363LF0000X	Family Nurse Practitioner	AP139187	TX
12	363LF0000X	Family Nurse Practitioner	0030633	OH
13	363LF0000X	Family Nurse Practitioner	0024183695	VA
14	363LF0000X	Family Nurse Practitioner	277001705	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP139187	OTHER	TX	APRN LICENSE

General Provider Information

NPI Number	:	1437625449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEDRE SHEPARD FNP-BC

Provider Business Mailing Address
First Line	:	1340 N HIGHWAY 377 STE 110
Second Line	:
City	:	PILOT POINT
State	:	TX
Zip	:	76258-3765
Country	:	US
Telephone Number	:	940-686-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	3827 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5089
Country	:	US
Telephone Number	:	303-500-1518
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	12/03/2025

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