Provider Demographics
NPI:1629071691
Name:SHARP, KELLEY J (NP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:J
Last Name:SHARP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E RICKERT AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1333
Mailing Address - Country:US
Mailing Address - Phone:615-260-5589
Mailing Address - Fax:615-446-0259
Practice Address - Street 1:207 E RICKERT AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1333
Practice Address - Country:US
Practice Address - Phone:615-260-5589
Practice Address - Fax:615-446-0259
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6660363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4058108OtherBLUE CROSS BLUE SHIELD TN
TNQ081360Medicaid
500014527OtherRAILROAD MEDICARE PIN
TN4058108OtherBLUE CROSS BLUE SHIELD TN
TN4058108OtherBLUE CROSS BLUE SHIELD TN
500014527OtherRAILROAD MEDICARE PIN