Healthcare Provider Details

I. General information

NPI: 1346229465
Provider Name (Legal Business Name): MICHELE MILLER SHARP P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAST PACK
MOUNDRIDGE KS
67107
US

IV. Provider business mailing address

200 EAST PACK
MOUNDRIDGE KS
67107
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-6322
  • Fax: 620-345-3038
Mailing address:
  • Phone: 620-345-6322
  • Fax: 620-345-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-01083
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: