Provider Demographics
NPI:1275703803
Name:SHARP, LEANN K (APN)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:K
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 1:709 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1575
Mailing Address - Country:US
Mailing Address - Phone:765-709-0500
Mailing Address - Fax:317-718-8438
Practice Address - Street 1:709 S 18TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1575
Practice Address - Country:US
Practice Address - Phone:765-709-0500
Practice Address - Fax:317-718-8438
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005012A2080P0006X, 363L00000X, 363LP0808X
IL209-006773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209385OtherMEDICARE GROUP