Healthcare Provider Details

I. General information

NPI: 1265865992
Provider Name (Legal Business Name): WHITNEY BONNER SPARKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 3RD ST
BELMONT MS
38827-7737
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-454-4520
  • Fax: 662-454-4521
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR883463
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: