Provider Demographics
NPI:1548445232
Name:SHARPE, LINDA FAYE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8014
Mailing Address - Country:US
Mailing Address - Phone:318-235-6019
Mailing Address - Fax:318-334-1595
Practice Address - Street 1:200 S 26TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8014
Practice Address - Country:US
Practice Address - Phone:318-235-6019
Practice Address - Fax:318-334-1595
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA801827347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548445232OtherSHARP MINDS
LA1021687Medicaid