Healthcare Provider Details

I. General information

NPI: 1801897830
Provider Name (Legal Business Name): MRS. DENISE H SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PHILLIP STONE WAY
CENTRAL CITY KY
42330-1929
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 270-754-3494
  • Fax:
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002089
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: