Healthcare Provider Details

I. General information

NPI: 1699215921
Provider Name (Legal Business Name): TAMMY SPARKS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 N WALNUT ST
CAMERON MO
64429-1341
US

IV. Provider business mailing address

921 N WALNUT ST
CAMERON MO
64429-1341
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-2111
  • Fax:
Mailing address:
  • Phone: 816-632-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024027180
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017004794
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: