=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467824581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNIE SPARKS AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 WATER PLANT RD
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-8615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-404-2474
-----------------------------------------------------
Fax | 919-375-4150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1303 WATER PLANT RD
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27597-8615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-404-2474
-----------------------------------------------------
Fax | 919-375-4150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN151090
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 342420
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 5018645
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------