Provider Demographics
NPI:1659866176
Name:SPARKS, LEEANN (CRNP)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ADAMS ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3759
Mailing Address - Country:US
Mailing Address - Phone:256-265-6512
Mailing Address - Fax:256-265-6727
Practice Address - Street 1:910 ADAMS ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3759
Practice Address - Country:US
Practice Address - Phone:256-265-6512
Practice Address - Fax:256-265-6727
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily