Provider Demographics
NPI:1881239259
Name:GERAGHTY, SHARON (APRN, RN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:APRN, RN
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 2117
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2117
Mailing Address - Country:US
Mailing Address - Phone:907-209-7385
Mailing Address - Fax:
Practice Address - Street 1:130 TRADING BAY RD STE 340
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9116
Practice Address - Country:US
Practice Address - Phone:907-374-0852
Practice Address - Fax:907-374-0854
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR15434163W00000X
AK179540363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner