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NPI Code Detail

MEDICARE: KRISTEN LYNN SPARKS MD

MEDICARE: KRISTEN LYNN SPARKS MD
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
12084P0800XPsychiatry PhysicianMD27400ME
22084P0800XPsychiatry PhysicianMED6829AK

General Provider Information

NPI Number : 1508954827
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN LYNN SPARKS MD
Provider Business Mailing Address
First Line : 268 STILLWATER AVE
Second Line :
City : BANGOR
State : ME
Zip : 04401-3945
Country : US
Telephone Number : 207-973-6100
Fax Number :
Provider Business Practice Location Address
First Line : 268 STILLWATER AVE
Second Line :
City : BANGOR
State : ME
Zip : 04401-3945
Country : US
Telephone Number : 207-973-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 11/05/2023

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