Provider Demographics
NPI:1861788861
Name:SPARKS, JENNIFER KEYES (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KEYES
Last Name:SPARKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST # 376
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-7234
Mailing Address - Fax:423-778-7245
Practice Address - Street 1:975 E 3RD ST # 376
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7234
Practice Address - Fax:423-778-7245
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily