Provider Demographics
NPI:1235674078
Name:MOULTON, SHARON DENISE (CRNP-FAMILY)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:MOULTON
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 NORTH LOOP W # 1100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1051
Mailing Address - Country:US
Mailing Address - Phone:877-637-8387
Mailing Address - Fax:832-320-3790
Practice Address - Street 1:2707 NORTH LOOP W # 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1051
Practice Address - Country:US
Practice Address - Phone:877-637-8387
Practice Address - Fax:832-320-3790
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR135140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily