Provider Demographics
NPI:1144634080
Name:SHARPE, MISTY NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:NICOLE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:CODY
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:16323 ALPHONSE FORBES RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-6317
Mailing Address - Country:US
Mailing Address - Phone:225-261-8860
Mailing Address - Fax:
Practice Address - Street 1:8303 OHARA CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6513
Practice Address - Country:US
Practice Address - Phone:225-231-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN102441363LP0808X
LAPA210074363LP0808X
LAAP07796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health