Provider Demographics
NPI:1124557616
Name:MALPASS, SHARRY JACKSON (DNP, NP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHARRY
Middle Name:JACKSON
Last Name:MALPASS
Suffix:
Gender:F
Credentials:DNP, NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2311
Mailing Address - Country:US
Mailing Address - Phone:910-592-6011
Mailing Address - Fax:910-592-0819
Practice Address - Street 1:403 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2399
Practice Address - Country:US
Practice Address - Phone:910-592-6011
Practice Address - Fax:910-592-0811
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily