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General NPI Number Information
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NPI Number | 1497391304
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Entity Type | Individual
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Provider Name | KATHY JO SHARP PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 1 JEFFERSON BARRACKS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4181
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Country | US
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Telephone | 314-652-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 119 FAIRVIEW TER
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City | JACKSONVILLE
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State | IL
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Zip | 62650-2283
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Country | US
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Telephone | 217-622-3870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209020474
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License Number State | IL
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