Basic Information
| Provider Information | |||||||||
| NPI: | 1386995124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGEE SPARKS | ||||||||
| FirstName: | LETTY | ||||||||
| MiddleName: | SUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3963 US HIGHWAY 220 N | ||||||||
| Address2: | |||||||||
| City: | SEAGROVE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273419588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368731010 | ||||||||
| FaxNumber: | 3368731010 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W WALKER AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272036760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366337000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | N | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home | 364SP0809X | 128314 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.