Healthcare Provider Details

I. General information

NPI: 1508656489
Provider Name (Legal Business Name): KATHRYN SHARP MS, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 REX AVE
JACKSON CA
95642-2020
US

IV. Provider business mailing address

572 ESTABROOK ST
SAN LEANDRO CA
94577-3512
US

V. Phone/Fax

Practice location:
  • Phone: 510-407-9448
  • Fax:
Mailing address:
  • Phone: 510-407-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250052082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: