Mary J Shephard, RD, RDN, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDN0000003448 Issued in TN

Practice address

301 Med Tech Pkwy Ste 240
Johnson City, TN 37604-2641

Phone

(423) 794-5520

Fax

(423) 282-6940

NPI assigned

Jan 29, 2019

Last updated

Apr 11, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• State of Franklin Healthcare Associates PLLC

  • Clinical Medical Laboratory
  • Johnson City, TN
  • NPI 1841846136
  NPD

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586563200000",
    "number": "1568926004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E SPRINGBROOK DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011761",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY STE 240",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042641",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHARD",
        "first_name": "MARY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "RD, RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2020-04-11",
        "certification_date": "2020-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "LDN0000003448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q056054",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bettina N Shelton, FNP-BC
• Heather P Shelton, FNP
• Katessia Leann Shelton, COTA/L
• Mung-Hua Shen
• Ann Ramsey Shepard, RN
• Alexandria Shepherd
• Dexter Shepherd, NP
• Mary Katherine Shepherd, PHARMD
• Matthew Sherban, D.M.D.
• Rebecca Sherfey, LPC-MHSP

• Registered Dietitian in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.