Individual
MRS. JENNIFER R SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1630 MILITARY CUTOFF RD, SUITE 110, WILMINGTON, NC 28403-5719
(910) 798-2318
(910) 798-2319
Mailing address
1630 MILITARY CUTOFF RD, SUITE 110, WILMINGTON, NC 28403-5719
(910) 798-2318
(910) 798-2319
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4865
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017WJ
BLUE CROSS BLUE SHIELD
NC
01
—
232058
HUMANA
NC
01
—
562099749
RPN
NC
01
—
562246243001
TRICARE
NC
05
—
7211054
—
NC
01
—
A6058
MEDCOST
NC
Enumeration date
01/31/2007
Last updated
05/26/2016
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