Provider Demographics
NPI:1760653174
Name:PAINE, SHARON L (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:PAINE
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 1:4211 JOE RAMSEY BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7856
Mailing Address - Country:US
Mailing Address - Phone:903-455-4767
Mailing Address - Fax:
Practice Address - Street 1:4264 STATE HIGHWEAY 66
Practice Address - Street 2:SUITE A
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6232
Practice Address - Country:US
Practice Address - Phone:903-527-0110
Practice Address - Fax:903-408-0111
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J629OtherMEDICARE GROUP
TX00J629OtherMEDICARE GROUP