Individual
DR. CHARISSE Y SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1809 W LOOP 281, SUITE 100-131, LONGVIEW, TX 75604-2571
(816) 262-2455
Mailing address
1809 W LOOP 281, SUITE 100-131, LONGVIEW, TX 75604-2571
(816) 262-2455
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
022981
MO
207XX0801X
Orthopaedic Trauma Physician
Primary
P1597
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001805100
CHP
MO
05
—
200326080A
—
KS
05
—
209342302
—
MO
01
—
35460011
BCBS KANSAS CITY
MO
01
—
719498
PHP HEALTHLINK
—
01
—
7230075
AETNA
MO
Enumeration date
07/19/2006
Last updated
03/13/2013
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