MEDICARE: ANNETTE SHARP MHPP

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1619259454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE SHARP MHPP

Provider Business Mailing Address
First Line	:	1600 ALDERSGATE RD
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6614
Country	:	US
Telephone Number	:	501-661-0720
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 E NORTH ST
Second Line	:
City	:	MAGNOLIA
State	:	AR
Zip	:	71753-3120
Country	:	US
Telephone Number	:	870-234-0739
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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