Provider Demographics
NPI:1558923649
Name:SMITH, SHARON (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SMITH
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 1:305 LIMESTONE TER STE C-3
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1293
Mailing Address - Country:US
Mailing Address - Phone:512-588-1501
Mailing Address - Fax:855-346-7410
Practice Address - Street 1:305 LIMESTONE TER STE C-3
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-1293
Practice Address - Country:US
Practice Address - Phone:512-588-1501
Practice Address - Fax:855-346-7410
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645807163W00000X
TXAP142473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse