Provider Demographics
NPI:1255677027
Name:SHARP, BRANDI NICOLE (APN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:SHARP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CONCORD LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4235
Mailing Address - Country:US
Mailing Address - Phone:870-378-0107
Mailing Address - Fax:870-424-2442
Practice Address - Street 1:421 W WADE AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4622
Practice Address - Country:US
Practice Address - Phone:870-424-5010
Practice Address - Fax:870-424-2442
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002271364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health