Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25408 | WV |
NPI | 1184815003 |
---|---|
Provider Name | Meagan Watts Shepherd |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007102 | (05) | LA |