Individual
KENDRA DIONNE SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1056 E RAINES RD, MEMPHIS, TN 38116-6337
(901) 300-5777
(901) 422-6092
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(901) 300-5777
(901) 422-6092
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
28922
AL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
61176
TN
390200000X
Student in an Organized Health Care Education/Training Program
28922
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051100368
BCBS
AL
05
—
08752708
—
MS
05
—
114403
—
AL
05
—
114406
—
AL
05
—
114409
—
AL
05
—
114416
—
AL
05
—
130354
—
AL
01
—
P00894317
RAILROAD MEDICARE
AL
Enumeration date
02/26/2007
Last updated
11/30/2021
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