Provider Demographics
NPI:1942451596
Name:SHARP, JODY RAE (NP-C)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:RAE
Last Name:SHARP
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:RAE
Other - Last Name:ENERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9568 155TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:ND
Mailing Address - Zip Code:58238-9721
Mailing Address - Country:US
Mailing Address - Phone:701-360-1133
Mailing Address - Fax:
Practice Address - Street 1:701 WEST SIXTH STREET
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1379
Practice Address - Country:US
Practice Address - Phone:701-352-4555
Practice Address - Fax:701-352-4480
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR16727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily