Healthcare Provider Details

I. General information

NPI: 1104737915
Provider Name (Legal Business Name): SHARRON FREEMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 WE CATT ST
WEST MEMPHIS AR
72301-2764
US

IV. Provider business mailing address

1105 WE CATT ST
WEST MEMPHIS AR
72301-2764
US

V. Phone/Fax

Practice location:
  • Phone: 901-364-4330
  • Fax:
Mailing address:
  • Phone: 901-364-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number050262960809E
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: