Provider Demographics
NPI:1497057046
Name:MITCHELL, SHARON JEANETTE (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JEANETTE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 NASH ST NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1127
Mailing Address - Country:US
Mailing Address - Phone:252-234-1720
Mailing Address - Fax:252-234-1721
Practice Address - Street 1:3725 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1127
Practice Address - Country:US
Practice Address - Phone:252-234-1720
Practice Address - Fax:252-234-1721
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6834AOtherMEDICARE PTAN
NC7006124Medicaid