Provider Demographics
NPI:1467458539
Name:PICKENS, SHARON M (APN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:PICKENS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 WILDWOOD AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5084
Mailing Address - Country:US
Mailing Address - Phone:501-992-1910
Mailing Address - Fax:501-992-1915
Practice Address - Street 1:2402 WILDWOOD AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5084
Practice Address - Country:US
Practice Address - Phone:501-992-1910
Practice Address - Fax:501-992-1915
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145853758Medicaid
ARP326000Medicare UPIN
AR5W429Medicare ID - Type UnspecifiedINDIVIDUAL AR MEDICARE ID