Healthcare Provider Details

I. General information

NPI: 1295008795
Provider Name (Legal Business Name): CHELSEY JOHNSON SPARKS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W MAIN ST
DECATURVILLE TN
38329-8078
US

IV. Provider business mailing address

115 E BROOKLYN ST P O BOX 916
LINDEN TN
37096-3515
US

V. Phone/Fax

Practice location:
  • Phone: 731-852-2761
  • Fax: 731-852-2781
Mailing address:
  • Phone: 931-589-2104
  • Fax: 931-589-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: