Provider Demographics
NPI:1477024560
Name:SPARKS, KIERA L (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:L
Last Name:SPARKS
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 S SHERWOOD FOREST BLVD STE 203B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2250
Mailing Address - Country:US
Mailing Address - Phone:225-291-5492
Mailing Address - Fax:
Practice Address - Street 1:3233 S SHERWOOD FOREST BLVD STE 203B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2250
Practice Address - Country:US
Practice Address - Phone:225-291-5492
Practice Address - Fax:225-291-5456
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator