Provider Demographics
NPI:1427538826
Name:SPARKS, KENNETH ERROL JR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ERROL
Last Name:SPARKS
Suffix:JR
Gender:M
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 1:1560 W BAY AREA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2669
Mailing Address - Country:US
Mailing Address - Phone:281-218-8181
Mailing Address - Fax:
Practice Address - Street 1:1560 W BAY AREA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2669
Practice Address - Country:US
Practice Address - Phone:281-218-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health