Provider Demographics
NPI:1821387325
Name:WALTER, SHARON HOOPER (PA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:HOOPER
Last Name:WALTER
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 1:200 HERLONG AVE S STE E
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1182
Mailing Address - Country:US
Mailing Address - Phone:803-366-5500
Mailing Address - Fax:
Practice Address - Street 1:200 HERLONG AVE S STE E
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-366-5500
Practice Address - Fax:803-366-5501
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02811363AM0700X
SC1644363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-02811OtherNC LICENSE