Provider Demographics
NPI:1124051693
Name:KORN, MICKI SHARPE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MICKI
Middle Name:SHARPE
Last Name:KORN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 EAST LAUREL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2248
Mailing Address - Country:US
Mailing Address - Phone:251-943-7901
Mailing Address - Fax:251-943-1949
Practice Address - Street 1:1090 EAST LAUREL AVENUE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2248
Practice Address - Country:US
Practice Address - Phone:251-943-7901
Practice Address - Fax:251-943-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-050138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891005690Medicaid
ALS01252Medicare UPIN
AL000032937Medicare ID - Type Unspecified
AL510I500019Medicare PIN