Provider Demographics
NPI:1609864974
Name:BECKWITH, SHARA M (CFNP)
Entity Type:Individual
Prefix:
First Name:SHARA
Middle Name:M
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-5678
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:205A BELLE MEADE PT
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3311
Practice Address - Country:US
Practice Address - Phone:601-200-5678
Practice Address - Fax:601-992-0096
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS782685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01022112OtherRAILROAD MEDICARE
MS08650772Medicaid
MSP01022112OtherRAILROAD MEDICARE
MSQ16857Medicare UPIN
MS08650772Medicaid
MS500001618Medicare PIN