Provider Demographics
NPI:1871500231
Name:SHARP, MISTY T (MD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:T
Last Name:SHARP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8695
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0012
Mailing Address - Country:US
Mailing Address - Phone:662-243-2435
Mailing Address - Fax:662-328-7037
Practice Address - Street 1:2110 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2210
Practice Address - Country:US
Practice Address - Phone:662-243-2435
Practice Address - Fax:662-328-7037
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4404207N00000X
MS19576207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159885001Medicaid
AR5N232OtherBCBS PPP PROVIDER #
AR159885001Medicaid