Individual
KRISTIN SHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
611 E DOUGLAS RD STE 406, MISHAWAKA, IN 46545-1468
(743) 335-6580
Mailing address
611 E DOUGLAS RD, MISHAWAKA, IN 46545-1464
(574) 335-6504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02006676A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300026890
—
IN
Enumeration date
03/20/2019
Last updated
12/06/2023
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