Active NPI
Bryan M Shepherd
- Family Nurse Practitioner
- Warrensburg, MO
National Provider Identifier
1457073140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2022021468
- Practice address
- 702 E Young Ave
Warrensburg, MO 64093-9610 - Phone
- (816) 922-2500
- NPI assigned
- Sep 19, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2022021468 | MO | Primary |
Addresses
Primary practice location
702 E Young Ave
Warrensburg, MO 64093-9610
Mailing address
4206 E 105TH Ter
Kansas City, MO 64137-1636
Phone (913) 709-1614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231004003359 | IA | Order and Referring Only - Nurse Practitioner | 8224483649 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022021468 | MO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1457073140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4206 E 105TH TER",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641371636",
"telephone_number": "913-709-1614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 E YOUNG AVE",
"city": "WARRENSBURG",
"state": "MO",
"postal_code": "640939610",
"telephone_number": "816-922-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "BRYAN",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2022021468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warrensburg, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.