Provider Demographics
NPI:1538434816
Name:THAXTON, SHARELL J (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:SHARELL
Middle Name:J
Last Name:THAXTON
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8584 WASHINGTON ST STE 2055
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5369
Mailing Address - Country:US
Mailing Address - Phone:216-404-6060
Mailing Address - Fax:440-708-0102
Practice Address - Street 1:12301 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1002
Practice Address - Country:US
Practice Address - Phone:216-778-4428
Practice Address - Fax:216-265-6801
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023369363LP0808X, 363LF0000X
OHRN.378816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse