| Kasey Shepherd Lscsw Llc | |
|
200 N Broadway Ave Ste 500 Wichita KS 67202-2322 | |
| (316) 425-7774 | |
| (316) 425-7779 |
| Full Name | Kasey Shepherd Lscsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 200 N Broadway Ave Ste 500, Wichita, Kansas |
| Authorized Official Name and Position | Nina M Williams (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3165162339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kasey Shepherd Lscsw Llc 200 N Broadway Ave Ste 500 Wichita KS 67202-2322 Ph: (316) 425-7774 | Kasey Shepherd Lscsw Llc 200 N Broadway Ave Ste 500 Wichita KS 67202-2322 Ph: (316) 425-7774 |
| NPI Number | 1063039139 |
|---|---|
| Provider Enumeration Date | 07/06/2020 |
| Last Update Date | 06/24/2024 |
| Certification Date | 05/07/2024 |
| Medicare PECOS PAC ID | 2062874746 |
|---|---|
| Medicare Enrollment ID | O20230811001499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063039139 | NPI | - | NPPES |
| 201259410A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kasey D Shepherd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902888423 PECOS PAC ID: 7810352085 Enrollment ID: I20230424002144 |
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