MEDICARE: RACHEL SPARKS NP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1215376827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACHEL SPARKS NP INC

Provider Business Mailing Address
First Line	:	2118 MIDNIGHT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-2562
Country	:	US
Telephone Number	:	832-603-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 MIDNIGHT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-2562
Country	:	US
Telephone Number	:	832-603-0018
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL SPARKS
Credential	:
Telephone Number	:	832-603-0018

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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