Provider Demographics
NPI:1508085689
Name:SHARP, MELISSA LAVON (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAVON
Last Name:SHARP
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LAVON
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2202 S CEDAR ST STE 330
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-272-5127
Mailing Address - Fax:253-272-0811
Practice Address - Street 1:2202 S CEDAR ST STE 330
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-272-5127
Practice Address - Fax:253-272-0811
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120054363A00000X
CAPA19038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8902484OtherMEDICARE PTAN (KING)
WAG8902483OtherMEDICARE PTAN (PIERCE)