| Shepherd Clinical Services, Llc | |
|
49 Old Hickory Blvd Jackson TN 38305-4551 | |
| (731) 343-8336 | |
| (731) 213-1915 |
| Full Name | Shepherd Clinical Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 49 Old Hickory Blvd, Jackson, Tennessee |
| Authorized Official Name and Position | Kristen Hansen (ADMINISTRATOR) |
| Authorized Official Contact | 7313438336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shepherd Clinical Services, Llc 29 N Star Dr Suite D Jackson TN 38305-6656 Ph: (731) 343-8336 | Shepherd Clinical Services, Llc 49 Old Hickory Blvd Jackson TN 38305-4551 Ph: (731) 343-8336 |
| NPI Number | 1548704620 |
|---|---|
| Provider Enumeration Date | 12/08/2016 |
| Last Update Date | 01/24/2019 |
| Medicare PECOS PAC ID | 6305118779 |
|---|---|
| Medicare Enrollment ID | O20170818002530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548704620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Alan B Hopkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063484129 PECOS PAC ID: 1759277213 Enrollment ID: I20040304000990 |
| Provider Name | Jonathan D Shaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669579116 PECOS PAC ID: 9830149293 Enrollment ID: I20050125000146 |
| Provider Name | Stephen E Collier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316058340 PECOS PAC ID: 8123078193 Enrollment ID: I20070125000195 |
| Provider Name | Laurie Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063693893 PECOS PAC ID: 9133200363 Enrollment ID: I20080114000713 |
| Provider Name | Radwan R Khuri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578530036 PECOS PAC ID: 8729989926 Enrollment ID: I20100421000461 |
| Provider Name | Robert Hamm |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700067642 PECOS PAC ID: 1052580206 Enrollment ID: I20130724000924 |
| Provider Name | Toni A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851781751 PECOS PAC ID: 4385962414 Enrollment ID: I20150421001436 |
| Provider Name | Sylvester A Nwedo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184060113 PECOS PAC ID: 9335448299 Enrollment ID: I20160427000374 |
| Provider Name | Michael Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609383082 PECOS PAC ID: 4082958772 Enrollment ID: I20181206002622 |
| Provider Name | Teresa Darlene Kendrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437406485 PECOS PAC ID: 4880849801 Enrollment ID: I20201110001516 |
| Provider Name | Renee Mathis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952919102 PECOS PAC ID: 4486061751 Enrollment ID: I20210402000586 |
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