Healthcare Provider Details

I. General information

NPI: 1720436785
Provider Name (Legal Business Name): SHARON RENEE NUNLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOLTON AVE E
BIG STONE GAP VA
24219-3350
US

IV. Provider business mailing address

13160 REEDY CREEK RD
BRISTOL VA
24202-3404
US

V. Phone/Fax

Practice location:
  • Phone: 423-239-9737
  • Fax:
Mailing address:
  • Phone: 276-285-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001225009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: