Provider Demographics
NPI:1790801991
Name:SPARKS, KARRA D (RD LD CDE)
Entity Type:Individual
Prefix:MS
First Name:KARRA
Middle Name:D
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3217
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715
Mailing Address - Country:US
Mailing Address - Phone:479-876-5499
Mailing Address - Fax:
Practice Address - Street 1:#4 HANOVER DRIVE
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714
Practice Address - Country:US
Practice Address - Phone:479-876-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK793133N00000X, 133V00000X
AR824133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered