Healthcare Provider Details

I. General information

NPI: 1689282642
Provider Name (Legal Business Name): JOSHUA W SHARP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HOGUE RD
PINE KNOT KY
42635-7003
US

IV. Provider business mailing address

PO BOX 300
PINE KNOT KY
42635-0300
US

V. Phone/Fax

Practice location:
  • Phone: 606-354-9444
  • Fax: 606-354-9449
Mailing address:
  • Phone: 606-354-9444
  • Fax: 606-354-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number238134
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: