Spark Integrative Wellness, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SPARK INTEGRATIVE WELLNESS, PLLC

Practice address

2700 S Roan St Ste 300a
Johnson City, TN 37601-7556

Phone

(423) 722-2422

Fax

(423) 722-2400

NPI assigned

Jan 8, 2025

Last updated

Jan 8, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Judy, APRNNPI 1326713280

Title

Pmhnp

Phone

(423) 491-9146

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer D Judy, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Johnson City, TN
  • NPI 1326713280

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1053121574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 S ROAN ST STE 300A",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376017556",
            "telephone_number": "423-722-2422",
            "fax_number": "423-722-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 S ROAN ST STE 300A",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376017556",
            "telephone_number": "423-722-2422",
            "fax_number": "423-722-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK INTEGRATIVE WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PMHNP",
        "authorized_official_telephone_number": "423-491-9146",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick David South, MD
• Southern Orthocare Inc
• Southside Senior Care LLC
• Michael L Spady, MD
• Sheila Price Spangler, OTR/L
• Bethany Carol Sparkman, LPC
• Sandra Hampton Sparks, NP-C
• Taylor Victoria Sparks, FNP
• Tommy A Sparks, NP
• Stacey W Sparrow, MSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.