Provider Demographics
NPI:1689282642
Name:SHARP, JOSHUA W
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:W
Last Name:SHARP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-0300
Mailing Address - Country:US
Mailing Address - Phone:606-354-9444
Mailing Address - Fax:606-354-9449
Practice Address - Street 1:57 HOGUE RD
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-7003
Practice Address - Country:US
Practice Address - Phone:606-354-9444
Practice Address - Fax:606-354-9449
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN238134163W00000X
KY3015666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse