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General NPI Number Information
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NPI Number | 1700392966
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Entity Type | Individual
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Provider Name | STEPHEN SPARKS CRNP
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Gender | Male
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Dates
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Enumeration Date | 12/22/2017
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 10 HOMESTEAD LN
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City | COCHRANVILLE
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State | PA
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Zip | 19330-9642
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Country | US
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Telephone | 610-406-2039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-302-9342
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Fax | 208-367-5180
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP018367
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 8271370
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License Number State | ID
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