Healthcare Provider Details

I. General information

NPI: 1275716276
Provider Name (Legal Business Name): BETTY ANN SPARKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PKWY SUITE 250
COLORADO SPRINGS CO
80910-6100
US

IV. Provider business mailing address

155 PRINTERS PKWY SUITE 250
COLORADO SPRINGS CO
80910-6100
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-3783
  • Fax: 719-667-5756
Mailing address:
  • Phone: 719-636-3783
  • Fax: 719-667-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number87995
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: