Provider Demographics
NPI:1528595808
Name:SHARP, JESSICA ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SHARP
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10939 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1900
Mailing Address - Country:US
Mailing Address - Phone:256-974-6550
Mailing Address - Fax:
Practice Address - Street 1:10939 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1900
Practice Address - Country:US
Practice Address - Phone:256-974-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL203125Medicaid