=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134274194
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES RODNEY SHARPE II APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 04/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2527 E PARKSIDE LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-7575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-910-4160
-----------------------------------------------------
Fax | 480-546-3203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2527 E PARKSIDE LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-7575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-910-4160
-----------------------------------------------------
Fax | 480-546-3203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 247414
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN207955
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------