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NPI Code Detail

MEDICARE: MRS. JESSICA BAMBURG SHARP F.N.P.

MEDICARE: MRS. JESSICA BAMBURG SHARP F.N.P.
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
1363LF0000XFamily Nurse PractitionerAPO5017LA

General Provider Information

NPI Number : 1629164280
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA BAMBURG SHARP F.N.P.
Provider Business Mailing Address
First Line : 183 GILMORE RD
Second Line :
City : WEST MONROE
State : LA
Zip : 71292-0174
Country : US
Telephone Number : 318-396-6005
Fax Number :
Provider Business Practice Location Address
First Line : 1117 CHENIERE DREW RD
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-8551
Country : US
Telephone Number : 318-329-4370
Fax Number : 318-329-4356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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