| NPI | 1023695707 |
|---|---|
| Former Name | JESSICA SPARKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN215662) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN215662) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2022-10-31 |