MEDICARE: JOAN RUSSELL SHEPHERD NP

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	0017137813	VA

General Provider Information

NPI Number	:	1689838294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN RUSSELL SHEPHERD NP

Provider Business Mailing Address
First Line	:	204 N HAMILTON ST
Second Line	:	SUITE 4
City	:	RICHMOND
State	:	VA
Zip	:	23221-2662
Country	:	US
Telephone Number	:	804-353-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 N HAMILTON ST
Second Line	:	SUITE 4
City	:	RICHMOND
State	:	VA
Zip	:	23221-2662
Country	:	US
Telephone Number	:	804-353-1230
Fax Number	:

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

Provider Enumeration Date	:	07/13/2008
Last Update Date	:	01/30/2018

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