Provider Demographics
NPI:1467276675
Name:HENRY KWARULA, SHARON (BAHS, CCSS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:HENRY KWARULA
Suffix:
Gender:F
Credentials:BAHS, CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GOLF DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3145
Mailing Address - Country:US
Mailing Address - Phone:806-476-9926
Mailing Address - Fax:
Practice Address - Street 1:105 GOLF DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3145
Practice Address - Country:US
Practice Address - Phone:806-476-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator