Provider Demographics
NPI:1134146921
Name:SOMMERVILLE, SHARON WOOTEN (NNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:WOOTEN
Last Name:SOMMERVILLE
Suffix:
Gender:
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 QUINCY DR DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-8197
Mailing Address - Country:US
Mailing Address - Phone:318-381-1833
Mailing Address - Fax:
Practice Address - Street 1:1214 QUINCY DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-8197
Practice Address - Country:US
Practice Address - Phone:318-381-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118118363LN0000X
LAAP04649363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1722880Medicaid
LA1134146921Medicaid
LAQ54115Medicare UPIN