Individual
PHILLIP D. SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 632-2230
(913) 632-2297
Mailing address
PO BOX 411895, KANSAS CITY, MO 64141-1895
(913) 632-2230
(913) 632-2297
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
96070
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
1036303
TX
367500000X
Certified Registered Nurse Anesthetist
557175
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201074920A
—
KS
01
—
49686013
BCBS KC
KS
01
—
P01231498
RAILROAD
KS
Enumeration date
04/08/2013
Last updated
05/22/2024
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