Provider Demographics
NPI:1477151116
Name:SPARKS, LAUREN JONES (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JONES
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CALLE VENADO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0153
Mailing Address - Country:US
Mailing Address - Phone:205-427-6363
Mailing Address - Fax:
Practice Address - Street 1:9 CALLE VENADO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0153
Practice Address - Country:US
Practice Address - Phone:205-427-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61286363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health