Provider Demographics
NPI:1013419225
Name:SPARKS, SANDRA HAMPTON (NP-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:HAMPTON
Last Name:SPARKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MICHELLE
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 N STATE OF FRANKLIN RD STE 400
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6051
Mailing Address - Country:US
Mailing Address - Phone:423-979-6000
Mailing Address - Fax:423-979-6011
Practice Address - Street 1:310 N STATE OF FRANKLIN RD STE 400
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6051
Practice Address - Country:US
Practice Address - Phone:423-979-6000
Practice Address - Fax:423-979-6011
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF02180713363LF0000X
TN24122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily