Provider Demographics
NPI:1730568338
Name:LOTT, SHARON (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4870
Mailing Address - Country:US
Mailing Address - Phone:903-609-3839
Mailing Address - Fax:903-783-1024
Practice Address - Street 1:305 N COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4870
Practice Address - Country:US
Practice Address - Phone:903-609-3839
Practice Address - Fax:903-783-1024
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128744363L00000X, 363LA2200X
OK83065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000000Medicaid