Provider Demographics
NPI:1407823354
Name:STEWART, SHARON (APRN)
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 5TH AVE W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2436
Mailing Address - Country:US
Mailing Address - Phone:615-384-7111
Mailing Address - Fax:615-384-5577
Practice Address - Street 1:105 5TH AVE W
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2436
Practice Address - Country:US
Practice Address - Phone:615-384-7111
Practice Address - Fax:615-384-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 8127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441523Medicaid
TN3649470Medicare PIN