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General NPI Number Information
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NPI Number | 1760337505
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Entity Type | Individual
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Provider Name | KIMBRA SPARKS NP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 9100 SW 182ND AVE
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City | BEAVERTON
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State | OR
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Zip | 97007-6052
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Country | US
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Telephone | 503-968-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 9100 SW 182ND AVE
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City | BEAVERTON
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State | OR
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Zip | 97007-6052
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Country | US
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Telephone | 503-968-2401
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Fax |
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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 | 10058451
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201602416RN
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License Number State | OR
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