Individual
MRS. MARY J SHEPHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, RDN, LDN
Contact information
Practice address
301 MED TECH PKWY STE 240, JOHNSON CITY, TN 37604-2641
(423) 794-5520
(423) 282-6940
Mailing address
215 E SPRINGBROOK DR, JOHNSON CITY, TN 37601-1761
(423) 794-5520
(423) 282-6940
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN0000003448
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q056054
—
TN
Enumeration date
01/29/2019
Last updated
04/11/2020
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