SHEPHERDS PEDIATRIC CARE (NPI# 1790108454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790108454 |
| Entity Type | Organization |
| Organization Name | SHEPHERDS PEDIATRIC CARE |
| Practice Address |
106 Circle Way St Suite A Lake Jackson TX 77566-5202 |
| Practice Telephone | 9792973949 |
| Practice Fax Number | 9792973919 |
| Mailing Telephone | 9792973949 |
| Mailing Fax Number | 9792973919 |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-03-10 |
| Authorized Official Name | DR. LONI LYNN SHEPHERD (OWNER) |
| Authorized Official Telephone | 9792973949 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
N6017 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 214871001 | 05 |
| Street Address |
106 CIRCLE WAY ST SUITE A |
| City | LAKE JACKSON |
| State | TX |
| Zip Code | 77566-5202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124678511 | Carolyn Celestine Charles | Nurse Practitioner | 106 Circle Way St, Lake Jackson, TX 77566-5266 | 2019-09-17 |
| 1740749217 | Horizon Safety LLC | Chiropractor | 106 Circle Way St, Lake Jackson, TX 77566-5266 | 2019-03-14 |
| 1679038921 | Amanda Nicole Garcia | Nurse Practitioner | 106 Circle Way St, Lake Jackson, TX 77566-5266 | 2019-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588271746 | Daniel Kent | Pharmacist | 121 Tx-332 W, Lake Jackson, TX 77566 | 2020-09-30 |
| 1134692403 | Gulf Coast Gastroenterology Lab | Clinical Medical Laboratory | 219 Oak Drive South, Suite A, Lake Jackson, TX 77566 | 2019-01-09 |
| 1194266288 | Kaitlin Dingee | Nurse Practitioner | 208 Oak Dr S Ste 502, Lake Jackson, TX 77566 | 2017-03-09 |
| 1326581935 | Nec Lake Jackson Emergency Center, Lp | Clinic/Center | 103 Winding Way, Lake Jackson, TX 77566 | 2016-11-30 |
| 1548618911 | Sara Eddy | Counselor | 109 Circle Way, Lake Jackson, TX 77566 | 2016-05-26 |
| 1689020158 | Baker Chiropractic Center Pllc | Chiropractor | 100-a Plantation Drive, Lake Jackson, TX 77566 | 2016-05-13 |
| 1326409368 | Janet Chen | Pharmacist | 131 Oyster Creek Dr., Lake Jackson, TX 77566 | 2016-03-18 |
| 1164819488 | Eco Dental Care, Pllc | Dentist | 210 Lake Rd, Ste 800 A, Lake Jackson, TX 77566 | 2015-04-24 |
| 1730578196 | Anna Katherine Tucker | Occupational Therapy Assistant | 1052 Cardinal Dr, Richwood, TX 77566 | 2015-01-22 |
| 1306243035 | H-e-b, Lp | Clinical Medical Laboratory | 97 Oyster Creek Drive, Lake Jackson, TX 77566 | 2014-11-24 |
| Find all providers in zip 77566 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932330917 | Kids Way Clinic | Clinic/Center | 201 Oak Dr S Ste 105, Lake Jackson, TX 77566-5627 | 2009-08-07 |
| 1881166791 | Tailored Weight Loss, LLC | Clinic/Center | 135 Oyster Creek Dr Ste B, Lake Jackson, TX 77566-4119 | 2018-12-18 |
| 1366812760 | Brazos Primary Care Associates | Clinic/Center | 201 Oak Dr S, Suite 102, Lake Jackson, TX 77566-5676 | 2015-09-29 |
| 1487048203 | Medical Care Innovation, P.C. | Clinic/Center | 270 Abner Jackson Pkwy, Lake Jackson, TX 77566-5124 | 2015-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323568 | Synergenx Health - Webster LLC | Clinic/Center | 19325 Gulf Fwy Ste 120, Webster, TX 77598-2812 | 2020-10-16 |
| 1821696253 | Bio Drip, LLC | Clinic/Center | 935 Sunland Park Dr Ste 103, El Paso, TX 79922-1369 | 2020-10-16 |
| 1821696386 | Blue Ocean Health Services LLC | Clinic/Center | 105 Clariden Ranch Rd, Southlake, TX 76092-1947 | 2020-10-15 |
| 1982202800 | Devoted Medical Group of Texas, Inc. | Clinic/Center | 20405 State Highway 249 Ste 325, Houston, TX 77070-2893 | 2020-10-13 |
| 1891392437 | Blum Health Pllc | Clinic/Center | 1387 George Dieter Dr Ste 106d, El Paso, TX 79936-7410 | 2020-10-06 |
| 1902403769 | Apogee Health Promotions | Clinic/Center | 105 Cottage Rd # B, Carthage, TX 75633-1507 | 2020-10-05 |
| 1447857255 | Fairgrounds Family Clinic Pllc | Clinic/Center | 4505 Hummingbird Ln N, Harlingen, TX 78552-2422 | 2020-10-05 |
| 1508463605 | Kk Martinez & Associates LLC | Clinic/Center | 13180 Fm 529 Rd Ste A, Houston, TX 77041-2652 | 2020-10-02 |
| 1659987022 | Specialists In Geriatric and Palliative Care Medicine Pllc | Clinic/Center | 8198 Walnut Hill Lane, Jackson Bldg, Suite 100, Dallas, TX 75231 | 2020-09-21 |
| 1518573443 | Elizabeth Danielle Benavides | Clinic/Center | 1424 Tanager Ct, San Antonio, TX 78260-2455 | 2020-09-16 |
| Find all providers with the same taxonomy | ||||
| City | LAKE JACKSON |
| Zip Code | 77566 |
Please comment or provide details below to improve the information on SHEPHERDS PEDIATRIC CARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.