Organization
SPARK INTEGRATIVE WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JUDY APRN (PMHNP)
(423) 491-9146
Entity
Organization
Contact information
Practice address
2700 S ROAN ST STE 300A, JOHNSON CITY, TN 37601-7556
(423) 722-2422
(423) 722-2400
Mailing address
2700 S ROAN ST STE 300A, JOHNSON CITY, TN 37601-7556
(423) 722-2422
(423) 722-2400
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/08/2025
Last updated
01/08/2025
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