Provider Demographics
NPI:1114049392
Name:SHARP, KIM (RN, MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:RN, MSN, ARNP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-0693
Mailing Address - Country:US
Mailing Address - Phone:360-849-4033
Mailing Address - Fax:360-849-4033
Practice Address - Street 1:291 NORTH WELCOME SLOUGH
Practice Address - Street 2:
Practice Address - City:CATHLAMET
Practice Address - State:WA
Practice Address - Zip Code:98612-0693
Practice Address - Country:US
Practice Address - Phone:360-849-4033
Practice Address - Fax:360-849-4033
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006862363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP082N5290Medicaid
TXP082N5290Medicaid