Healthcare Provider Details

I. General information

NPI: 1275703803
Provider Name (Legal Business Name): LEANN K SHARP APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S 18TH ST
LAFAYETTE IN
47905-1575
US

IV. Provider business mailing address

709 S 18TH ST
LAFAYETTE IN
47905-1575
US

V. Phone/Fax

Practice location:
  • Phone: 765-709-0500
  • Fax: 317-718-8438
Mailing address:
  • Phone: 765-709-0500
  • Fax: 317-718-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number71005012A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005012A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-006773
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71005012A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: