Healthcare Provider Details

I. General information

NPI: 1013848316
Provider Name (Legal Business Name): CAITLYN POWELL SPARKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

4186 HARPER HOUSE RD
FOUR OAKS NC
27524-8874
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-8171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number304898
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: