Individual
MISS JACQUELINE SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7001
Mailing address
5913 HALLOWELL PL, FORT WAYNE, IN 46815-6214
(815) 272-5409
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10004291A
IN
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065613
—
OH
Enumeration date
01/03/2024
Last updated
03/30/2026
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