Provider Demographics
NPI:1861019895
Name:SHEPHERD, TIFFANY RAYCHELLE (BSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RAYCHELLE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:RAYCHELLE
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12005 E 470 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3737
Mailing Address - Country:US
Mailing Address - Phone:918-342-0770
Mailing Address - Fax:918-342-0087
Practice Address - Street 1:12005 E 470 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3737
Practice Address - Country:US
Practice Address - Phone:918-342-0770
Practice Address - Fax:918-342-0087
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator