Provider Demographics
NPI:1639228273
Name:KIRVEN, SHARON DENETT (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENETT
Last Name:KIRVEN
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 1:2030 N BELT LINE RD
Mailing Address - Street 2:STE 130
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5815
Mailing Address - Country:US
Mailing Address - Phone:469-804-3498
Mailing Address - Fax:972-329-1203
Practice Address - Street 1:2030 N BELT LINE RD
Practice Address - Street 2:STE 130
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5815
Practice Address - Country:US
Practice Address - Phone:469-804-3498
Practice Address - Fax:972-329-1203
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043015903Medicaid
TX043015904Medicaid
TX043015905Medicaid
TX043015906Medicaid
TX8M5094OtherBCBS
TXTXB132347Medicare PIN
TXTXB132348Medicare PIN
TX8G2278Medicare PIN
TX043015906Medicaid
TX043015903Medicaid