Provider Demographics
NPI:1801870548
Name:FARLEY, SHARON L (CRNA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:FARLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:423-224-4746
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100049120Medicaid
00013869OtherNHC CARE ADMINISTRATORS
TN0100OtherJOHN DEERE
TN3635197Medicaid
4106657OtherBLUE SHIELD OF TN
KY74010117OtherKY MEDICAID
VA010188228Medicaid
TN3635197Medicaid
TN100049120Medicaid