Provider Demographics
NPI:1073291308
Name:LOUD, SPARKLE JOHNAE
Entity Type:Individual
Prefix:
First Name:SPARKLE
Middle Name:JOHNAE
Last Name:LOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 BUTTE STREET
Mailing Address - Street 2:A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-560-8376
Mailing Address - Fax:
Practice Address - Street 1:2345 BUTTE STREET
Practice Address - Street 2:A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-560-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide