Provider Demographics
NPI:1265118681
Name:SPARKS, CARTER CHRISTIAN
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:CHRISTIAN
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 1:3186 US-412
Mailing Address - Street 2:
Mailing Address - City:WEST SILOAM SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74338-8237
Mailing Address - Country:US
Mailing Address - Phone:844-458-2100
Mailing Address - Fax:
Practice Address - Street 1:3186 US-412
Practice Address - Street 2:
Practice Address - City:WEST SILOAM SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74338
Practice Address - Country:US
Practice Address - Phone:844-458-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator