Provider Demographics
NPI:1558454934
Name:BAILEY, SHARON L (DNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:307-733-3636
Mailing Address - Fax:877-205-2024
Practice Address - Street 1:625 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8642
Practice Address - Country:US
Practice Address - Phone:307-733-3636
Practice Address - Fax:877-205-2024
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS134183311363L00000X
COAPN.0990028-NP363LA2200X, 363LA2100X
WY4566363LA2100X
CONP-990028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420580AMedicaid
WY137169000Medicaid
CO72357550Medicaid
CO72357550Medicaid
COCOA105440Medicare PIN
COCOA105440Medicare PIN