Shepherds Pediatric Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

N6017 Issued in TX

Legal business name

SHEPHERDS PEDIATRIC CARE

Practice address

106 Circle Way St
Suite a
Lake Jackson, TX 77566-5202

Phone

(979) 297-3949

Fax

(979) 297-3919

NPI assigned

Jan 30, 2014

Last updated

Mar 10, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Loni Lynn Shepherd, M.D.NPI 1073704268

Title

Owner

Phone

(979) 297-3949

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Loni Lynn Shepherd, MD

  • Pediatrics Physician
  • Lake Jackson, TX
  • NPI 1073704268
  NPD Authorized official

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1790108454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 CIRCLE WAY ST",
            "address_2": "SUITE A",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665202",
            "telephone_number": "979-297-3949",
            "fax_number": "979-297-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CIRCLE WAY ST",
            "address_2": "SUITE A",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665202",
            "telephone_number": "979-297-3949",
            "fax_number": "979-297-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERDS PEDIATRIC CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "LONI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-297-3949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "N6017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214871001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian K Shandley, OD
• Darrin C. Shandley, OD
• Nicholas Shawver, LPC, LSOTP, LCDC-I
• Abdul Moid Shehzad, MD
• Loni Lynn Shepherd, MD
• Roghayeh Shirdel
• Linda Hoda Shook, SLP
• Umair Mahmood Siddiqui, MD
• Kelci Page Sikes, PT
• Ashley Nicole Mae Simms

• Primary Care Clinic/Center in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; 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.