Provider Demographics
NPI:1528115987
Name:SPARKS, CHRISTINA KAY (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KAY
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1000
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9482
Mailing Address - Country:US
Mailing Address - Phone:812-847-9502
Mailing Address - Fax:812-847-1825
Practice Address - Street 1:2121 E HWY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441
Practice Address - Country:US
Practice Address - Phone:812-847-9496
Practice Address - Fax:812-847-1825
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28117375A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse