Provider Demographics
NPI:1316901390
Name:HENDRICKS, SHARON L (DNP/ENP/FNP/AGACNP)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DNP/ENP/FNP/AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3058
Mailing Address - Country:US
Mailing Address - Phone:719-691-4979
Mailing Address - Fax:719-691-7733
Practice Address - Street 1:1208 LUTHER STREET
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:CO
Practice Address - Zip Code:81036
Practice Address - Country:US
Practice Address - Phone:719-438-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170012367A00000X
CO990110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8HH136OtherMEDICARE PTAN
COMH1116373OtherDEA
CO22057331Medicaid
MT8HH137OtherMEDICARE PTAN