Provider Demographics
NPI:1679093850
Name:SHARPE, PAMELA (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SHARPE
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 1:1 CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1815
Mailing Address - Country:US
Mailing Address - Phone:937-641-3555
Mailing Address - Fax:
Practice Address - Street 1:9775 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1442
Practice Address - Country:US
Practice Address - Phone:513-853-9700
Practice Address - Fax:513-852-8971
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022606363LF0000X
IN28242617A363LF0000X
OHAPRNCNP022606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383163Medicaid
IN201213770AMedicaid
OH0320009Medicaid