Healthcare Provider Details

I. General information

NPI: 1871533075
Provider Name (Legal Business Name): CYNTHIA MARLENE SHARP APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BRYAN BLVD
CORBIN KY
40701
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-1172
  • Fax: 606-528-7169
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003795
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: