Provider Demographics
NPI:1982217204
Name:SPARKS, RACHEL (LVN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 FM 1504
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-6559
Mailing Address - Country:US
Mailing Address - Phone:430-207-1848
Mailing Address - Fax:
Practice Address - Street 1:4731 FM 1504
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-6559
Practice Address - Country:US
Practice Address - Phone:430-207-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347520164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse