Provider Demographics
NPI:1740255439
Name:SHARP, RYAN D (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:D
Last Name:SHARP
Suffix:
Gender:M
Credentials:PA-C
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 6939
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0939
Mailing Address - Country:US
Mailing Address - Phone:402-436-2000
Mailing Address - Fax:402-436-2090
Practice Address - Street 1:6900 A ST
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4120
Practice Address - Country:US
Practice Address - Phone:402-436-2000
Practice Address - Fax:402-436-2090
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1004363AM0700X, 363AS0400X
COPA.0003403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91177983268510A015OtherTRICARE
NE970023869OtherRAILROAD MEDICARE
NE23520OtherMIDLANDS CHOICE
NE91177983268510A015OtherTRICARE
NE970023869OtherRAILROAD MEDICARE