Provider Demographics
NPI:1346229465
Name:SHARP, MICHELE MILLER (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MILLER
Last Name:SHARP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EAST PACK
Mailing Address - Street 2:
Mailing Address - City:MOUNDRIDGE
Mailing Address - State:KS
Mailing Address - Zip Code:67107
Mailing Address - Country:US
Mailing Address - Phone:620-345-6322
Mailing Address - Fax:620-345-3038
Practice Address - Street 1:200 EAST PACK
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107
Practice Address - Country:US
Practice Address - Phone:620-345-6322
Practice Address - Fax:620-345-3038
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01083363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS426960OtherBLUE CROSS BLUE SHIELD
KS460684Medicaid
KS15419OtherPREFERRED HEALTH SYSTEMS
KSQ38728Medicare UPIN
KS110273Medicare ID - Type UnspecifiedGROUP NUMBER
KS460684Medicaid