Provider Demographics
NPI:1427538826
Name:SPARKS, KENNETH ERROL JR (FNP-BC PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ERROL
Last Name:SPARKS
Suffix:JR
Gender:M
Credentials:FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 HICKORY TER
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-1423
Mailing Address - Country:US
Mailing Address - Phone:713-325-3250
Mailing Address - Fax:
Practice Address - Street 1:5441 S MACADAM AVE STE 8044
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:503-446-4700
Practice Address - Fax:503-446-4701
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10020804363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily