Healthcare Provider Details

I. General information

NPI: 1861327033
Provider Name (Legal Business Name): KSL EVENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HICKORY RIDGE RD
EDMONTON KY
42129-8910
US

IV. Provider business mailing address

210 HICKORY RIDGE RD
EDMONTON KY
42129-8910
US

V. Phone/Fax

Practice location:
  • Phone: 270-792-1653
  • Fax:
Mailing address:
  • Phone: 270-792-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH JASON SPARKS
Title or Position: OWNER
Credential: SPARKS
Phone: 270-792-1653