Provider Demographics
NPI:1518427293
Name:SPARKS, MARY KAY (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2917
Mailing Address - Country:US
Mailing Address - Phone:717-840-2730
Mailing Address - Fax:717-840-2741
Practice Address - Street 1:2251 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2917
Practice Address - Country:US
Practice Address - Phone:717-840-2730
Practice Address - Fax:717-840-2741
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN666595163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse