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General NPI Number Information
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NPI Number | 1336282102
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Entity Type | Individual
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Provider Name | PENNY SPARKS FNP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 249 BILLINGSLEY RD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1003
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Country | US
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Telephone | 704-336-6445
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Fax | 704-336-4709
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Provider Business Mailing Address
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Address Line | 9909 PROVIDENCE FOREST LN
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City | CHARLOTTE
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State | NC
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Zip | 28270-0216
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Country | US
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Telephone | 704-847-8099
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Fax | 704-336-4709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200026
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License Number State | NC
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