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NPI Code Detail

MEDICARE: BREANNE GAIL SHEPHERD

MEDICARE: BREANNE GAIL 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1568325132
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNE GAIL SHEPHERD
Provider Business Mailing Address
First Line : 686 LESTER ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5025
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 686 LESTER ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5025
Country : US
Telephone Number : 573-686-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ BREANNE GAIL SHEPHERD ” Practice Location

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