Provider Demographics
NPI:1184509192
Name:GOLDEN SPARROW HEALTH, PLLC
Entity type:Organization
Organization Name:GOLDEN SPARROW HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:501-382-1977
Mailing Address - Street 1:827 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5224
Mailing Address - Country:US
Mailing Address - Phone:501-382-1977
Mailing Address - Fax:501-271-4411
Practice Address - Street 1:827 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5224
Practice Address - Country:US
Practice Address - Phone:501-382-1977
Practice Address - Fax:501-271-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center