Provider Demographics
NPI:1073744553
Name:SPARKS, LAUREN HALL (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:HALL
Last Name:SPARKS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 COUNTY ROAD 4101
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:MS
Mailing Address - Zip Code:38856-6253
Mailing Address - Country:US
Mailing Address - Phone:662-423-8604
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3354
Practice Address - Country:US
Practice Address - Phone:662-720-3000
Practice Address - Fax:662-720-3069
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily