Provider Demographics
NPI:1811799604
Name:SHEPPARD, KARLY ALEXA (FNP-C)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:ALEXA
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3018
Mailing Address - Country:US
Mailing Address - Phone:314-681-6947
Mailing Address - Fax:
Practice Address - Street 1:5200 EXECUTIVE CENTRE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3809
Practice Address - Country:US
Practice Address - Phone:636-229-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025006818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily