MEDICARE: KIMBRA SPARKS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	201602416RN	OR

General Provider Information

NPI Number	:	1760337505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBRA SPARKS NP

Provider Business Mailing Address
First Line	:	9100 SW 182ND AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-6052
Country	:	US
Telephone Number	:	503-968-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 SW 182ND AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-6052
Country	:	US
Telephone Number	:	503-968-2401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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