Provider Demographics
NPI:1164521548
Name:SCRUGGS, SHARON L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials: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:PO BOX 291
Mailing Address - Street 2:336 EUREKA STREET
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39168-0291
Mailing Address - Country:US
Mailing Address - Phone:601-785-4322
Mailing Address - Fax:601-785-6881
Practice Address - Street 1:336 EUREKA STREET
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39168-0291
Practice Address - Country:US
Practice Address - Phone:601-785-4322
Practice Address - Fax:601-785-6881
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR764114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117436Medicaid
MSS21338Medicare UPIN
MS500001856Medicare PIN