Healthcare Provider Details

I. General information

NPI: 1073898680
Provider Name (Legal Business Name): HEATHER LYNNEA SHARP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N HIGHLAND PARK AVE
CHATTANOOGA TN
37404-2016
US

IV. Provider business mailing address

455 N HIGHLAND PARK AVE
CHATTANOOGA TN
37404-2016
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-6070
  • Fax:
Mailing address:
  • Phone: 423-209-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: