MEDICARE: PAULINE KELLIE SPARKS

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	376J00000X	Homemaker
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1902747363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE KELLIE SPARKS

Provider Business Mailing Address
First Line	:	21 MCLEAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1333
Country	:	US
Telephone Number	:	704-449-5530
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 MCLEAN ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1333
Country	:	US
Telephone Number	:	704-449-5530
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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Directions to “ PAULINE KELLIE SPARKS ” Practice Location

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