Provider Demographics
NPI:1174527899
Name:CLEVENGER, SHARON FREEMAN (MA, MSN, PMHCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:FREEMAN
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:MA, MSN, PMHCNS-BC
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:E
Other - Last Name:MORGILLO FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, APRN-CS, MAC
Mailing Address - Street 1:423 AIRPORT NORTH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6704
Mailing Address - Country:US
Mailing Address - Phone:260-969-5583
Mailing Address - Fax:260-969-5584
Practice Address - Street 1:423 AIRPORT NORTH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6704
Practice Address - Country:US
Practice Address - Phone:260-969-5583
Practice Address - Fax:260-969-5584
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000153A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1612OtherPHP
IN1612OtherPHP
IN220730AMedicare Oscar/Certification