Provider Demographics
NPI:1396509758
Name:SHARP PEDIATRICS LLC
Entity type:Organization
Organization Name:SHARP PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER PEDIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-260-5589
Mailing Address - Street 1:207 E RICKERT AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1333
Mailing Address - Country:US
Mailing Address - Phone:615-260-5589
Mailing Address - Fax:615-446-0259
Practice Address - Street 1:207 E RICKERT AVE
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1333
Practice Address - Country:US
Practice Address - Phone:629-932-5437
Practice Address - Fax:629-932-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ081360Medicaid