Provider Demographics
NPI:1881073211
Name:SPARKS, KANSAS N (DO)
Entity type:Individual
Prefix:
First Name:KANSAS
Middle Name:N
Last Name:SPARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 APALACHEE PKWY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3636
Mailing Address - Country:US
Mailing Address - Phone:850-755-9252
Mailing Address - Fax:850-546-6278
Practice Address - Street 1:2702 APALACHEE PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3636
Practice Address - Country:US
Practice Address - Phone:850-755-9252
Practice Address - Fax:850-546-6278
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine