MEDICARE: SHARON LYNN GILLIAM MSN CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APN0000006063	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4088754	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013090422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LYNN GILLIAM MSN CRNP

Provider Business Mailing Address
First Line	:	150 JACK FARRAR LN
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2398
Country	:	US
Telephone Number	:	931-455-2766
Fax Number	:	931-455-2829

Provider Business Practice Location Address
First Line	:	150 JACK FARRAR LN
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-2398
Country	:	US
Telephone Number	:	931-455-2766
Fax Number	:	931-455-2829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/13/2013

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