Healthcare Provider Details

I. General information

NPI: 1194461277
Provider Name (Legal Business Name): SHARON L HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIMBERWOLF LN
HUNTINGTON WV
25704-9377
US

IV. Provider business mailing address

1653 HIGHWAY 581
ULYSSES KY
41264-9046
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-1699
  • Fax:
Mailing address:
  • Phone: 304-785-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number57726
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: