MEDICARE: MS. SHARON MARIE ELLISON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1609401827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON MARIE ELLISON

Provider Business Mailing Address
First Line	:	7946 GOODWOOD BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7629
Country	:	US
Telephone Number	:	225-590-3313
Fax Number	:	225-590-3324

Provider Business Practice Location Address
First Line	:	11616 SOUTHFORK AVE STE 403
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5241
Country	:	US
Telephone Number	:	225-261-7143
Fax Number	:	225-250-1026

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	04/09/2026

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