MEDICARE: TELINA MICHELLE SHARPSTON

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	343900000X	Non-emergency Medical Transport (VAN)	82-2121981	TN

General Provider Information

NPI Number	:	1417479403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TELINA MICHELLE SHARPSTON

Provider Business Mailing Address
First Line	:	212 STULTS STORE RD
Second Line	:
City	:	IRON CITY
State	:	TN
Zip	:	38463-6511
Country	:	US
Telephone Number	:	256-443-0733
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 STULTS STORE RD
Second Line	:
City	:	IRON CITY
State	:	TN
Zip	:	38463-6511
Country	:	US
Telephone Number	:	256-443-0733
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/21/2022

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