Provider Demographics
NPI:1659775591
Name:SHARMA, KRISTEN NICOLE (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:GACKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:4550 E BELL RD STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9385
Mailing Address - Country:US
Mailing Address - Phone:480-443-8400
Mailing Address - Fax:480-443-8697
Practice Address - Street 1:3048 E BASELINE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204
Practice Address - Country:US
Practice Address - Phone:480-505-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant