Provider Demographics
NPI:1417017047
Name:JOSEPHSON KEEVEN, SHARON R (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:R
Last Name:JOSEPHSON KEEVEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:R
Other - Last Name:JOSEPHSON KEEVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 EAST JEFFERSON STREET
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4236
Practice Address - Country:US
Practice Address - Phone:703-383-5409
Practice Address - Fax:703-383-5489
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN52236363L00000X
VA0024151294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24203Medicare UPIN
011755M92Medicare ID - Type Unspecified