Provider Demographics
NPI:1790735298
Name:SHARP, LORI (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:10820 KINGSTON PIKE STE 11
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3065
Practice Address - Country:US
Practice Address - Phone:865-675-6720
Practice Address - Fax:833-908-2118
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN996363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003937Medicaid
TNTN01J4OtherJOHN DEERE HEALTHCARE
TN4073686OtherBLUECROSS BLUESHIELD
TNTN01J5OtherJOHN DEERE HEALTHCARE
TNP00052160OtherRAILROAD MEDICARE
TN4124943OtherBLUECROSS BLUESHIELD SURG. ASSIST
P87277Medicare UPIN
TN4124943OtherBLUECROSS BLUESHIELD SURG. ASSIST