Provider Demographics
NPI:1104358803
Name:SHARP-BUCKNOR, SIMONE KEINIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:KEINIA
Last Name:SHARP-BUCKNOR
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:2400 MOUNT ZION PKWY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2500
Mailing Address - Country:US
Mailing Address - Phone:470-303-4249
Mailing Address - Fax:770-603-3675
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:470-303-4249
Practice Address - Fax:770-603-3675
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN150311163WL0100X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn