Healthcare Provider Details

I. General information

NPI: 1114633054
Provider Name (Legal Business Name): BRITTNEE RENE SHARP APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTNEE SHOEMAKER RN

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N MAIN ST STE 19A
CLOVIS NM
88101-3575
US

IV. Provider business mailing address

212 CHANTICLEER PL
CLOVIS NM
88101-9300
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-0049
  • Fax:
Mailing address:
  • Phone: 575-309-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: