Provider Demographics
NPI:1952639650
Name:SHARP, KENDALL LAURA (APRN, CPNP-AC/PC)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LAURA
Last Name:SHARP
Suffix:
Gender:F
Credentials:APRN, CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3078
Mailing Address - Country:US
Mailing Address - Phone:512-324-0197
Mailing Address - Fax:
Practice Address - Street 1:5339 N IH 35 STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2558
Practice Address - Country:US
Practice Address - Phone:512-628-1898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588212363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX588212OtherTEXAS BOARD OF NURSE EXAMINERS
TX208868401Medicaid
TX8L23471Medicare PIN