Provider Demographics
NPI:1235447301
Name:SPARKS, LI (L AU)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:L AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 BUTTERMILK PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1674
Mailing Address - Country:US
Mailing Address - Phone:513-328-5600
Mailing Address - Fax:513-828-6928
Practice Address - Street 1:562 BUTTERMILK PIKE STE A
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1674
Practice Address - Country:US
Practice Address - Phone:513-328-5600
Practice Address - Fax:513-828-6928
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC030171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist