Provider Demographics
NPI:1366482150
Name:SLOUP, SHARON NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:NICOLE
Last Name:SLOUP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 ROSE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3363
Mailing Address - Country:US
Mailing Address - Phone:205-339-3000
Mailing Address - Fax:205-339-0177
Practice Address - Street 1:952 ROSE DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3363
Practice Address - Country:US
Practice Address - Phone:205-339-3000
Practice Address - Fax:205-339-0177
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1072424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-44266OtherBC BS OF AL
AL100091Medicaid
AL51550575OtherBLUE CROSS BLUE SHIELD
ALP00463558OtherRAILROAD MEDICARE
AL051550575Medicaid
AL051550575Medicare ID - Type Unspecified
AL051550575Medicaid
AL510I500074Medicare PIN