Provider Demographics
NPI:1548280928
Name:SPARKS, SHILREY JEAN (RN, ADMINISTRATOR)
Entity type:Individual
Prefix:MRS
First Name:SHILREY
Middle Name:JEAN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RN, ADMINISTRATOR
Other - Prefix:
Other - First Name:GENERATIONS
Other - Middle Name:HOME
Other - Last Name:HEALTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1290 S WILLIS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4068
Mailing Address - Country:US
Mailing Address - Phone:325-690-5913
Mailing Address - Fax:325-690-1890
Practice Address - Street 1:1290 S WILLIS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4068
Practice Address - Country:US
Practice Address - Phone:325-690-5913
Practice Address - Fax:325-690-1890
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009922372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457924Medicare ID - Type UnspecifiedMEDICARE PROVIDER