MEDICARE: KIRSTEN K BRADFORD SHARP PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	TC079	KY
2	363AM0700X	Medical Physician Assistant	781	WV
3	363AM0700X	Medical Physician Assistant	PA1180	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457463911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN K BRADFORD SHARP PA-C

Provider Business Mailing Address
First Line	:	1055 DOVE RUN RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3536
Country	:	US
Telephone Number	:	859-268-0061
Fax Number	:	859-266-1152

Provider Business Practice Location Address
First Line	:	1055 DOVE RUN RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3536
Country	:	US
Telephone Number	:	859-268-0061
Fax Number	:	859-266-1152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/19/2009

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