Provider Demographics
NPI:1699215921
Name:SPARKS, TAMMY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-1341
Mailing Address - Country:US
Mailing Address - Phone:816-632-2111
Mailing Address - Fax:
Practice Address - Street 1:921 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1341
Practice Address - Country:US
Practice Address - Phone:816-632-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024027180363LP0808X
MO2017004794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health