Provider Demographics
NPI:1790460269
Name:SPARKS, BENJAMIN ASHBY (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ASHBY
Last Name:SPARKS
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:393 E RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7124
Mailing Address - Country:US
Mailing Address - Phone:435-359-2364
Mailing Address - Fax:408-356-1742
Practice Address - Street 1:393 E RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7124
Practice Address - Country:US
Practice Address - Phone:435-359-2364
Practice Address - Fax:408-356-1742
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13477889-8900363LP0808X
AZ227138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health