Provider Demographics
NPI:1225021199
Name:SHARP, KATHY LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNNE
Last Name:SHARP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-7009
Mailing Address - Country:US
Mailing Address - Phone:276-469-4200
Mailing Address - Fax:276-469-4249
Practice Address - Street 1:349 ISLAND RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-7009
Practice Address - Country:US
Practice Address - Phone:276-469-4200
Practice Address - Fax:276-469-4249
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5498363L00000X
VA0024171902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3901278Medicaid
TN103I501411Medicare PIN
TN3901278Medicaid
TN3901270Medicare PIN
TNS71070Medicare UPIN