Provider Demographics
NPI:1760848253
Name:COLBERT, SHARHONDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHARHONDA
Middle Name:
Last Name:COLBERT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHARHONDA
Other - Middle Name:
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3515 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0711
Mailing Address - Country:US
Mailing Address - Phone:903-791-9355
Mailing Address - Fax:903-793-0496
Practice Address - Street 1:3515 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0711
Practice Address - Country:US
Practice Address - Phone:903-791-9355
Practice Address - Fax:903-793-0496
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004660363LF0000X
TXAP129791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR473624YX6XOtherMEDICARE
TX489672YKVAOtherMEDICARE
TX489672YKVAMedicare Oscar/Certification
AR473624YX6XMedicare Oscar/Certification