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General NPI Number Information
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NPI Number | 1336440023
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Entity Type | Organization
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Legal Business Name | J. NEAL SHARPE, M.D. SURGICAL WOUND SPECIALIST, PLLC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 10821 PLANTSIDE DR SUITE 104
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City | LOUISVILLE
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State | KY
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Zip | 40299-6132
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Country | US
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Telephone | 502-412-2995
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Fax | 502-412-8025
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Provider Business Mailing Address
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Address Line | 10821 PLANTSIDE DR SUITE 104
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City | LOUISVILLE
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State | KY
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Zip | 40299-6132
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Country | US
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Telephone | 502-412-2995
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Fax | 502-412-8025
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Authorized Official
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Title or Position | OWNER
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Name | J. NEAL SHARPE
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Credential | M.D.
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Telephone | 502-412-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3002826
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24075
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License Number State | KY
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