Basic Information
| Provider Information | |||||||||
| NPI: | 1750616801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEMORE | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2078 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762346156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402499009 | ||||||||
| FaxNumber: | 9406271654 | ||||||||
| Practice Location | |||||||||
| Address1: | 2014 BEN MERRITT DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DECATUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762343850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406278982 | ||||||||
| FaxNumber: | 9406277597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2009 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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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 | AP 118607 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 327855801 | 05 | TX | MEDICAID | 8999ND | 01 | TX | BCBS | OTHER |