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NPI Code Detail

MEDICARE: STACY SHEPHERD

MEDICARE: STACY SHEPHERD
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
145-3589857OTHERTHE HOLMAN GROUP

General Provider Information

NPI Number : 1558871574
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY SHEPHERD
Provider Business Mailing Address
First Line : 5080 CALIFORNIA AVE STE 250
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0732
Country : US
Telephone Number : 661-258-3240
Fax Number :
Provider Business Practice Location Address
First Line : 5080 CALIFORNIA AVE STE 250
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0732
Country : US
Telephone Number : 661-258-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2017
Last Update Date : 07/03/2023

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Directions to “ STACY SHEPHERD ” Practice Location

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