Provider Demographics
NPI:1386931467
Name:SHARROCK, KATIE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:SHARROCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844555
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4555
Mailing Address - Country:US
Mailing Address - Phone:540-891-8730
Mailing Address - Fax:540-891-5742
Practice Address - Street 1:110 KINGSLEY LANE
Practice Address - Street 2:SUITE 305
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4617
Practice Address - Country:US
Practice Address - Phone:757-889-5942
Practice Address - Fax:757-889-5450
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2017-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA1097948363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical