Provider Demographics
NPI:1013562958
Name:SHARP, KATHRYN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-9302
Mailing Address - Country:US
Mailing Address - Phone:806-626-4943
Mailing Address - Fax:
Practice Address - Street 1:1607 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3455
Practice Address - Country:US
Practice Address - Phone:641-828-5019
Practice Address - Fax:641-828-5066
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical