Individual
MRS. KATHLEEN JO SHEPPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNPC
Contact information
Practice address
727 SE MAIN ST STE 300, SIMPSONVILLE, SC 29681-3249
(864) 522-1170
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1718
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0643
—
SC
01
—
P01072950
RR MEDICARE
SC
Enumeration date
09/13/2007
Last updated
03/18/2021
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