Healthcare Provider Details

I. General information

NPI: 1639074941
Provider Name (Legal Business Name): FEED YOUR SPARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 SOUTH AVE
SPRINGFIELD MO
65807-5220
US

IV. Provider business mailing address

3623 SOUTH AVE
SPRINGFIELD MO
65807-5220
US

V. Phone/Fax

Practice location:
  • Phone: 417-319-4281
  • Fax:
Mailing address:
  • Phone: 417-365-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LINDSAY MEGAN SPARKS
Title or Position: OWNER
Credential: RDN, LD
Phone: 417-365-1998