Provider Demographics
NPI:1639265465
Name:SPARKS, DONNA JEAN (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 729
Mailing Address - Street 2:319 FIFTH AVE.
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370
Mailing Address - Country:US
Mailing Address - Phone:276-496-4492
Mailing Address - Fax:276-496-4839
Practice Address - Street 1:13168 MEADOWVIEW SQUARE
Practice Address - Street 2:MEADOWVIEW COMMUNITY HEALTH
Practice Address - City:MEADOWVIEW
Practice Address - State:VA
Practice Address - Zip Code:24361
Practice Address - Country:US
Practice Address - Phone:276-944-3999
Practice Address - Fax:276-944-3882
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024107429363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010062411Medicaid
VA010062411Medicaid
VAC08575Medicare PIN
P13282Medicare UPIN
VAP13282Medicare UPIN