=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619664034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARPE PSYCHIATRIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2023
-----------------------------------------------------
Last Update Date | 04/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2527 E PARKSIDE LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-7575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-829-8101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 72615
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-910-4160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-BC/OWNER
-----------------------------------------------------
Name | MR. CHARLES RODNEY SHARPE II
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 480-910-4160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------