Healthcare Provider Details

I. General information

NPI: 1326115486
Provider Name (Legal Business Name): REBELEE C SHARP-BYRN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/12/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 COMMERCE DRIVE
GREENSBURG KY
42743
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-932-2424
  • Fax: 270-932-2522
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1422
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: