Provider Demographics
NPI:1902260805
Name:GILGENAST, SHARON (BS,)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GILGENAST
Suffix:
Gender:F
Credentials:BS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 CLOVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4714
Mailing Address - Country:US
Mailing Address - Phone:931-538-0261
Mailing Address - Fax:
Practice Address - Street 1:1279 CLOVERDALE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4714
Practice Address - Country:US
Practice Address - Phone:931-538-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness