Provider Demographics
NPI:1447977681
Name:SPARKS, KAELYN BRETT (APRN)
Entity type:Individual
Prefix:
First Name:KAELYN
Middle Name:BRETT
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAELYN
Other - Middle Name:BRETT
Other - Last Name:SHERLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2315
Mailing Address - Country:US
Mailing Address - Phone:864-941-8100
Mailing Address - Fax:
Practice Address - Street 1:14 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4246
Practice Address - Country:US
Practice Address - Phone:864-250-7944
Practice Address - Fax:864-250-9582
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily