Provider Demographics
NPI:1174544563
Name:CRUM, SHARON DALE (FNP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DALE
Last Name:CRUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 LICKSKILLET RD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-8174
Mailing Address - Country:US
Mailing Address - Phone:252-333-5895
Mailing Address - Fax:
Practice Address - Street 1:995 LICKSKILLET RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8174
Practice Address - Country:US
Practice Address - Phone:252-333-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4028194363LF0000X
NC5001749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174544563Medicaid
NCNCE931AMedicare PIN