Individual
SHARON OTHELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4780 I 55 N STE 100-119, JACKSON, MS 39211-5542
(404) 806-4301
(470) 200-0836
Mailing address
3869 MONCURE MARBLE RD, TERRY, MS 39170-8855
(601) 503-0142
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
853949
MS
Other
Enumeration date
11/11/2025
Last updated
11/15/2025
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