Kelly L. Sparks, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

109 Bridge St Ste 300
Danville, VA 24541-1222

Phone

(434) 793-4711

Fax

(434) 797-2514

NPI assigned

Feb 17, 2006

Last updated

Aug 6, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Morgan Health Services, Inc

  • Family Medicine Physician
  • Martinsville, IN
  • NPI 1033110564
  NPD (past)
• Morgan Physician Specialists, LLC

  • Surgery Physician
  • Martinsville, IN
  • NPI 1104827633
  NPD (past)

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1649245309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 BRIDGE ST STE 300",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411222",
            "telephone_number": "434-793-4711",
            "fax_number": "434-797-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 BRIDGE ST STE 300",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411222",
            "telephone_number": "434-793-4711",
            "fax_number": "434-797-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "KELLY",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000928A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "85080096",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110007007",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "VVX692A",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0110007007",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.spectrummed.com",
            "affiliation": "N",
            "address_1": "109 Bridge St Ste 300",
            "city": "Danville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "245411222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Southern Assisted Living, LLC (Brookdale Danville Piedmont)
• Southern Virginia Consultant Pharmacy LLC
• Southern Virginia Mental Health Institute
• Southside Surgical Specialists PC
• Allison Marie Sparks
• Spectrum Medical Inc
• Spectrum Medical Inc
• Speech & Occupational Therapy Specialists
• Whitnie Spencer-Chaney, BAS, CSAC-S
• Rashaun Spencer, MD

• Surgical Physician Assistant in Danville, VA
• Providers in Danville, VA by specialty
• Surgical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.