Provider Demographics
NPI:1295008795
Name:SPARKS, CHELSEY JOHNSON (APRN-BC)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:JOHNSON
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E BROOKLYN ST
Mailing Address - Street 2:P O BOX 916
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-3515
Mailing Address - Country:US
Mailing Address - Phone:931-589-2104
Mailing Address - Fax:931-589-2513
Practice Address - Street 1:187 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATURVILLE
Practice Address - State:TN
Practice Address - Zip Code:38329-8078
Practice Address - Country:US
Practice Address - Phone:731-852-2761
Practice Address - Fax:731-852-2781
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528159Medicaid