Provider Demographics
NPI:1457463911
Name:BRADFORD SHARP, KIRSTEN K (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:K
Last Name:BRADFORD SHARP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 DOVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3536
Mailing Address - Country:US
Mailing Address - Phone:859-268-0061
Mailing Address - Fax:859-266-1152
Practice Address - Street 1:1055 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3536
Practice Address - Country:US
Practice Address - Phone:859-268-0061
Practice Address - Fax:859-266-1152
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC079363AM0700X
WV781363AM0700X
KYPA1180363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95004255Medicaid
WVSH6031693Medicare ID - Type Unspecified
KY95004255Medicaid
KY0693056Medicare PIN