Individual
MRS. KELSEY ANN SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9275 MONTGOMERY RD, MONTGOMERY, OH 45242-7779
(513) 936-4510
(513) 936-4511
Mailing address
2830 VICTORY PARKWAY, PAYOR ENROLLMENT, CINCINNATI, OH 45206-1785
(513) 585-5507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.139926
OH
207R00000X
Internal Medicine Physician
57.029553
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2017
Last updated
07/23/2020
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