=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528115987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA KAY SPARKS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 E HWY 54
-----------------------------------------------------
City | LINTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-847-9496
-----------------------------------------------------
Fax | 812-847-1825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 1 BOX 1000
-----------------------------------------------------
City | LINTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47441-9482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-847-9502
-----------------------------------------------------
Fax | 812-847-1825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 28117375A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------