Basic Information
| Provider Information | |||||||||
| NPI: | 1033170477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GULLEDGE | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436621502 | ||||||||
| FaxNumber: | 8436783611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 MARLBORO WAY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BENNETTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295122494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434795890 | ||||||||
| FaxNumber: | 8434793524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 795 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00254936 | 01 | SC | RAILROAD MEDICARE | OTHER |