Healthcare Provider Details

I. General information

NPI: 1982510723
Provider Name (Legal Business Name): AARON MICHAEL SPARKS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 4TH ST
DANVILLE WV
25053-4632
US

IV. Provider business mailing address

300 4TH ST
DANVILLE WV
25053-4632
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1230
  • Fax:
Mailing address:
  • Phone: 304-369-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number127336
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: