Provider Demographics
NPI:1053348995
Name:SHEPARD, JENNIFER INEZ (LVN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:INEZ
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:INEZ
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31ST & BATTALION
Practice Address - Street 2:BENNETT HEALTH CLINIC BDG # 420
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-318-8100
Practice Address - Fax:254-618-8099
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX182542164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse