Provider Demographics
NPI:1184490666
Name:SPARKMAN, DELORIS ALICE
Entity type:Individual
Prefix:
First Name:DELORIS
Middle Name:ALICE
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:
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 606
Mailing Address - Street 2:
Mailing Address - City:CORNETTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41731-0606
Mailing Address - Country:US
Mailing Address - Phone:606-216-8277
Mailing Address - Fax:
Practice Address - Street 1:101 TOWN AND COUNTRY LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9524
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily