Basic Information
| Provider Information | |||||||||
| NPI: | 1477024560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPARKS | ||||||||
| FirstName: | KIERA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BACHELOR OF SCIENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3233 S SHERWOOD FOREST BLVD STE 203B | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708162250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252915492 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3233 S SHERWOOD FOREST BLVD STE 203B | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708162250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252915492 | ||||||||
| FaxNumber: | 2252915456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.