Provider Demographics
NPI:1134662836
Name:SPARKS, ANGELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 BECKLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24733
Mailing Address - Country:US
Mailing Address - Phone:304-431-5499
Mailing Address - Fax:
Practice Address - Street 1:3997 BECKLEY ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24733
Practice Address - Country:US
Practice Address - Phone:304-431-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN82079-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily