Provider Demographics
NPI:1861069429
Name:SHEPHERD, KRISTA MICHELE (RN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICHELE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WEBB LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-6796
Mailing Address - Country:US
Mailing Address - Phone:502-321-2449
Mailing Address - Fax:
Practice Address - Street 1:119 E SANDERS LN
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7557
Practice Address - Country:US
Practice Address - Phone:502-251-3821
Practice Address - Fax:502-251-3822
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1129569364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1129569OtherLICENSE NUMBER