Provider Demographics
NPI:1760050819
Name:SPARKMAN, AUSTIN CHANDLER (PA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:CHANDLER
Last Name:SPARKMAN
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:808 MELANIE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 STACY LANE RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7356
Practice Address - Country:US
Practice Address - Phone:606-723-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-08-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant