Individual provider Active NPI

Jeremy Douglas Shepherd

  • Family Nurse Practitioner
  • Clarksville, TN
National Provider Identifier
1134944788
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
37981 Issued in TN
Practice address
651 Dunlop LN
Clarksville, TN 37040-5015
Phone
(931) 502-1000
NPI assigned
Nov 19, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Paramedic 146L00000X
Registered Nurse 163W00000X 259150 TN
Family Nurse Practitioner 363LF0000X 37981 TN Primary

Addresses

Primary practice location

651 Dunlop LN
Clarksville, TN 37040-5015

Mailing address

651 Dunlop LN
Clarksville, TN 37040-5015
Phone (931) 502-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250701002874 TN Practitioner - Nurse Practitioner 5193238327 Reassigns benefits to 1 organization
I20260106002294 KY Practitioner - Nurse Practitioner 5193238327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

520 W Gum St
Marion, KY 42064-1516
Phone (270) 965-1042

651 Dunlop LN
Clarksville, TN 37040-5015
Phone (931) 502-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
259150TNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Clinic PSC Family Current Accepting new patients
Crittenden Community Hospital LLC CurrentSince Dec 1, 2025 Accepting new patients
Southeastern Emergency Physicians LLC CurrentSince Apr 25, 2025 Accepting new patients
Crittenden Community Hospital LLC CurrentSince Dec 1, 2025 Accepting new patients

Locations

1325 Highway 76
Clarksville, TN 37043
Phone (615) 788-9324

651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

265 Brookview Centre Way
Ste 203
Knoxville, TN 37919
Phone (865) 500-1254

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/critten-2b2d21fb

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1134944788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405015",
            "telephone_number": "931-502-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405015",
            "telephone_number": "931-502-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "JEREMY",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-19",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "259150",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "37981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.