Provider Demographics
NPI:1316901390
Name:HENDRICKS, SHARON L (AGACNP-BC/FNP-C/CNM)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:AGACNP-BC/FNP-C/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3953
Mailing Address - Country:US
Mailing Address - Phone:719-336-3179
Mailing Address - Fax:719-336-7228
Practice Address - Street 1:401 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3942
Practice Address - Country:US
Practice Address - Phone:719-336-4343
Practice Address - Fax:719-336-7207
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170012367A00000X
CO990110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT8HH137OtherMEDICARE PTAN
CO22057331Medicaid
MT8HH136OtherMEDICARE PTAN