Provider Demographics
NPI:1538890470
Name:SHEPPARD, DEMEATRICE RENEE
Entity type:Individual
Prefix:
First Name:DEMEATRICE
Middle Name:RENEE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CHESNUT LN
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432-3815
Mailing Address - Country:US
Mailing Address - Phone:430-262-2930
Mailing Address - Fax:
Practice Address - Street 1:751 CHESNUT LN
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-3815
Practice Address - Country:US
Practice Address - Phone:430-262-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22029104172A00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver