Healthcare Provider Details

I. General information

NPI: 1538930276
Provider Name (Legal Business Name): DANA SHARP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MAIN ST
PERKINSTON MS
39573-3374
US

IV. Provider business mailing address

PO BOX 548
PERKINSTON MS
39573-0011
US

V. Phone/Fax

Practice location:
  • Phone: 601-928-6362
  • Fax:
Mailing address:
  • Phone: 601-928-6362
  • Fax: 601-528-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0465
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: