Provider Demographics
NPI:1033837786
Name:BROWN, SHARON NICHELLE (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:NICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 SW TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5040
Mailing Address - Country:US
Mailing Address - Phone:580-291-6280
Mailing Address - Fax:
Practice Address - Street 1:5508 SW TYLER AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5040
Practice Address - Country:US
Practice Address - Phone:580-291-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279396363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care