Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN219759 | GA |
NPI | 1407360084 |
---|---|
Provider Name | Brandi Lynn Sheppard |
First Address | Macon, GA 31201-2102 |
Second Address | Macon, GA 31201-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2017 |
Last Update Date | 26/06/2020 |