Provider Demographics
NPI:1194995597
Name:SPARKS, KIMBERLY C (AUD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:SPARKS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2402
Mailing Address - Country:US
Mailing Address - Phone:757-507-0340
Mailing Address - Fax:757-507-0341
Practice Address - Street 1:1139 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2402
Practice Address - Country:US
Practice Address - Phone:757-507-0340
Practice Address - Fax:757-507-0341
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist