Provider Demographics
NPI:1760297618
Name:SPARKS, HERBERT (KPSS)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:KPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 KY 1555
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-5455
Mailing Address - Country:US
Mailing Address - Phone:859-962-7892
Mailing Address - Fax:
Practice Address - Street 1:2639 KY 1555
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-5455
Practice Address - Country:US
Practice Address - Phone:859-962-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist