Provider Demographics
NPI:1538457759
Name:SHARP, KINZIE G (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KINZIE
Middle Name:G
Last Name:SHARP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2073 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4003
Mailing Address - Country:US
Mailing Address - Phone:773-665-4016
Mailing Address - Fax:773-960-6200
Practice Address - Street 1:2073 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4003
Practice Address - Country:US
Practice Address - Phone:773-665-4106
Practice Address - Fax:773-360-6200
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant