Provider Demographics
NPI:1164760757
Name:SHARP, KRYSTAL MARIE (LPA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:SHARP
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 E CROSS MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-2521
Mailing Address - Country:US
Mailing Address - Phone:513-368-5154
Mailing Address - Fax:
Practice Address - Street 1:396 E CROSS MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050-2521
Practice Address - Country:US
Practice Address - Phone:513-368-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2013-07103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical