Healthcare Provider Details

I. General information

NPI: 1528782356
Provider Name (Legal Business Name): SHAREE BIRKETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

IV. Provider business mailing address

247 CLEARVIEW CIR
RUSTBURG VA
24588-3263
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-7130
  • Fax:
Mailing address:
  • Phone: 540-570-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185377
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: