Individual provider Active NPI

Kristina Marie Sheppard, LCSW

  • Clinical Social Worker
  • Glendale, AZ
National Provider Identifier
1740119981
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
23793 Issued in AZ
Practice address
5757 W Thunderbird Rd Ste E454
Glendale, AZ 85306-4646
Phone
(480) 870-3010
Fax
(480) 716-6990
NPI assigned
May 14, 2026
Sex
Unspecified or another gender identity
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 23793 AZ Primary

Addresses

Primary practice location

5757 W Thunderbird Rd Ste E454
Glendale, AZ 85306-4646

Mailing address

2850 N Country Club Rd
Tucson, AZ 85716-1910
Phone (520) 322-6274

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260612000841 AZ Practitioner - Clinical Social Worker 9537631346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2850 N Country Club Rd
Tucson, AZ 85716-1910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23793AZMDClinical Social Worker

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1778716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778716800000",
    "number": "1740119981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 N COUNTRY CLUB RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857161910",
            "telephone_number": "520-322-6274",
            "fax_number": "520-509-4496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 W THUNDERBIRD RD STE E454",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064646",
            "telephone_number": "480-870-3010",
            "fax_number": "480-716-6990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPPARD",
        "first_name": "KRISTINA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2026-05-14",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "23793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.