MEDICARE: ALISHA NICHOLE SPARKS

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225709975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISHA NICHOLE SPARKS

Provider Business Mailing Address
First Line	:	2933 FRANCIS SCOTT KEY WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-6559
Country	:	US
Telephone Number	:	614-749-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 FRANCIS SCOTT KEY WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-6559
Country	:	US
Telephone Number	:	614-749-0806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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Directions to “ ALISHA NICHOLE SPARKS ” Practice Location

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