Provider Information for 1629839329
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BETHANY CAROL SPARKMAN LPC
Sex: Female
NPI: 1629839329
Last Updated: 2024-07-03
Certification Date: 2024-07-03
Certification Date: 2024-07-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629839329 | ||||||||
| Enumeration Date | 2024-01-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1021 W OAKLAND AVE STE 310 JOHNSON CITY, TN 37604-2192 United States Phone: 423-302-6565 | Fax: | ||||||||
| Primary Practice Address | 701 MED TECH PKWY STE 201 JOHNSON CITY, TN 37604-2365 United States Phone: 423-302-3480 | Fax: | ||||||||
| Secondary Practice Address(es) | 900 BUFFALO ST | ||||||||
| Health Information Exchange |
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