Provider Demographics
NPI:1811589914
Name:SPARKS, FARREN
Entity Type:Individual
Prefix:
First Name:FARREN
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3294 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:QUINWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25981-7005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3294 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:QUINWOOD
Practice Address - State:WV
Practice Address - Zip Code:25981-7005
Practice Address - Country:US
Practice Address - Phone:304-992-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker