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Individual

STACEY D SPARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
845 OLIVE ST, SHREVEPORT, LA 71104-2141
(318) 226-4892
(318) 227-4927
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
205277
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1515728
LA
Enumeration date
04/15/2009
Last updated
02/08/2019
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