MEDICARE: MS. GINGER ELAINE SHEPPARD LD

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	133V00000X	Registered Dietitian	DT81999	TX

General Provider Information

NPI Number	:	1891156790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINGER ELAINE SHEPPARD LD

Provider Business Mailing Address
First Line	:	512 W MLK JR BLVD # 148
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1231
Country	:	US
Telephone Number	:	512-868-6012
Fax Number	:	512-842-7227

Provider Business Practice Location Address
First Line	:	710 N 64TH ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-4387
Country	:	US
Telephone Number	:	512-686-6012
Fax Number	:	512-842-7227

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

Provider Enumeration Date	:	03/19/2016
Last Update Date	:	03/19/2016

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