Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 904654 | MS |
NPI | 1194397067 |
---|---|
Provider Name | Lynn Carol Sharp |
First Address | Terry, MS 39170-9506 |
Second Address | Jackson, MS 39204-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
904654 | (05) | MS |
905654 | (05) | MS |