Active NPI
Thomas Akers Shepard, PA-C
- Physician Assistant
- Pueblo, CO
National Provider Identifier
1578694378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 64
- Practice address
- 4112 Outlook Blvd
Suite 37
Pueblo, CO 81008-1667 - Phone
- (719) 562-6300
- Fax
- (719) 562-6375
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 64 | CO | Primary |
Addresses
Primary practice location
4112 Outlook Blvd
Suite 37
Pueblo, CO 81008-1667
Mailing address
4112 Outlook Blvd
Suite 37
Pueblo, CO 81008-1667
Phone (719) 562-6300
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64 | CO | MD | Anesthesiologist Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268611200000",
"number": "1578694378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4112 OUTLOOK BLVD",
"address_2": "SUITE 37",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081667",
"telephone_number": "719-562-6300",
"fax_number": "719-562-6375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4112 OUTLOOK BLVD",
"address_2": "SUITE 37",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081667",
"telephone_number": "719-562-6300",
"fax_number": "719-562-6375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD",
"first_name": "THOMAS",
"middle_name": "AKERS",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2010-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "64",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.