Provider Demographics
NPI:1699176750
Name:WILSON-SHARP, JACKIE (FNP)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:WILSON-SHARP
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 1:470 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6294
Mailing Address - Country:US
Mailing Address - Phone:423-286-4141
Mailing Address - Fax:423-286-4145
Practice Address - Street 1:3826 NORMA RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4408
Practice Address - Country:US
Practice Address - Phone:423-663-2920
Practice Address - Fax:423-663-3989
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017081Medicaid