Provider Demographics
NPI:1194221564
Name:CRAY, SHARON LAKISHA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LAKISHA
Last Name:CRAY
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 1:45 LIBBY AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-5952
Mailing Address - Country:US
Mailing Address - Phone:404-805-2637
Mailing Address - Fax:
Practice Address - Street 1:45 LIBBY AVE
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-5952
Practice Address - Country:US
Practice Address - Phone:404-805-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN196687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily