| NPI | 1336321827 |
|---|---|
| Former Name | NICOLE JEAN SHEPHARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 1665) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 1665) |
| 363AS0400X Physician Assistant, Surgical (Licence: OK 1665) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2019-04-23 |