Provider Demographics
NPI:1831882901
Name:SALLIE, SHARON DENISE (PMHNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:SALLIE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DENISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 FINKS HIDEAWAY RD APT 251
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2371
Mailing Address - Country:US
Mailing Address - Phone:318-235-9711
Mailing Address - Fax:
Practice Address - Street 1:224 FINKS HIDEAWAY RD APT 251
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2371
Practice Address - Country:US
Practice Address - Phone:318-235-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230301363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health