Devona Lynn Shepard

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

528731 Issued in OR

Practice address

312 NW 9TH St
Ontario, OR 97914-2252

Phone

(208) 741-0741

NPI assigned

Nov 5, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1881295921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 NW 9TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142252",
            "telephone_number": "208-741-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 NW 9TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979142252",
            "telephone_number": "208-741-0741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 SW 8th Ave",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "OR",
            "postal_code": "979143316",
            "country_code": "US",
            "telephone_number": "208-741-0741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "DEVONA",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-05",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "OR",
            "license": "519197",
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "OR",
            "license": "528731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6898",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kimberly Siguenza-Ramos

• Assisted Living Facility (Behavioral Disturbances) in Ontario, OR
• Providers in Ontario, OR by specialty
• Assisted Living Facility (Behavioral Disturbances) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.