Sparks, Kellie Richelle
Sparks, Kellie Richelle is an sole proprietor health care provider with primary practice located at 645 Interstate Dr , Grayson KY 41143-1704. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Sparks, Kellie Richelle can be contacted via phone (606) 474-0669.Contact Information
Primary practice address
645 Interstate Dr
Grayson KY 41143-1704
Phone: (606) 474-0669
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 3010258 | Kentucky |
Profile Details
| NPI number | 1083062988 |
|---|---|
| LBN Legal business name | Sparks, Kellie Richelle |
| Credentials | Advanced Practice Registered Nurse (APRN) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 1st, 2016 |
| Last updated | Apr 14th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083062988 | NPPES |
| Kentucky | MEDICAID | 7100419400 | |
| Kentucky | MEDICAID | 0170248 |
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