Active NPI
Maryanne Shephard, NURSE PRACTIONER
- Primary Care Nurse Practitioner
- Ellaville, GA
National Provider Identifier
1437232667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- RN058330
- Practice address
- 72 S. Broad St.
Ellaville, GA 30806-0065 - Phone
- (229) 937-5321
- Fax
- (229) 937-2232
- NPI assigned
- Oct 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | RN058330 | GA | Primary |
Addresses
Primary practice location
72 S. Broad St.
Ellaville, GA 30806-0065
Mailing address
PO Box 65
Ellaville, GA 31806-0065
Phone (229) 937-5321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000019F | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sumter Regional Hospital | Past | Accepting new patients | |
| Phoebe Sumter Medical Center, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Phoebe Sumter Ellaville Clinic
- Rural Health Clinic/Center
- Ellaville, GA
- NPI 1376778001
-
dba Ellaville Primary Medicine Center
- Rural Health Clinic/Center
- Ellaville, GA
- NPI 1487719076
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437232667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 65",
"city": "ELLAVILLE",
"state": "GA",
"postal_code": "318060065",
"telephone_number": "229-937-5321",
"fax_number": "229-937-2232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 S. BROAD ST.",
"city": "ELLAVILLE",
"state": "GA",
"postal_code": "308060065",
"telephone_number": "229-937-5321",
"fax_number": "229-937-2232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHARD",
"first_name": "MARYANNE",
"name_prefix": "Mrs.",
"credential": "NURSE PRACTIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "GA",
"license": "RN058330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00000019F",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ellaville, GA
- Laura Noel Register
- Sandra Reynolds
- Schley County Board of Health
- Schley County Commissioner (Schley County EMS)
- Schley County Schools
- Kristy Joy Smith, FNP-C
- Laci Smith, RN
- Southwest Ga Primary Care, LLC
- Sumter Regional Hospital (Ellaville Primary Medicine Center)
- Sumter Regional Hospital (Ellaville Primary Medicine Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.