Healthcare Provider Details

I. General information

NPI: 1447341482
Provider Name (Legal Business Name): VALERIE D SPARKS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE FRYE CRNA

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/31/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR
LOGAN WV
25601-3452
US

IV. Provider business mailing address

250 WOODLAND HILLS DR
CHAPMANVILLE WV
25508-5830
US

V. Phone/Fax

Practice location:
  • Phone: 304-831-1138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN58864
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: