Healthcare Provider Details

I. General information

NPI: 1992424279
Provider Name (Legal Business Name): SALLY DAY SHARP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTHLAKE AVE STE 207
RIDGELAND MS
39157-1717
US

IV. Provider business mailing address

201 NORTHLAKE AVE STE 207
RIDGELAND MS
39157-1717
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-4696
  • Fax:
Mailing address:
  • Phone: 601-366-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905536
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: