Provider Demographics
NPI:1932521374
Name:GANEY, SHARON BOURDON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:BOURDON
Last Name:GANEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30762 STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5672
Mailing Address - Country:US
Mailing Address - Phone:251-626-0732
Mailing Address - Fax:
Practice Address - Street 1:30762 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5672
Practice Address - Country:US
Practice Address - Phone:251-626-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125908208VP0000X, 363L00000X
FLARNP 9375017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1025023I102Medicare PIN