Provider Demographics
NPI:1861924920
Name:SHEPHERD, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:SHEPHERD
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 1:4297 6TH ST SE
Mailing Address - Street 2:APT 302
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3675
Mailing Address - Country:US
Mailing Address - Phone:202-749-4112
Mailing Address - Fax:
Practice Address - Street 1:4297 6TH ST SE
Practice Address - Street 2:APT 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3675
Practice Address - Country:US
Practice Address - Phone:202-749-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant