Healthcare Provider Details

I. General information

NPI: 1275128183
Provider Name (Legal Business Name): ALYSSA JANAE SHARPE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 02/01/2022
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27101-3006
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-9800
  • Fax:
Mailing address:
  • Phone: 336-713-4039
  • Fax: 336-716-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257434
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5015278
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: