Provider Demographics
NPI:1114179900
Name:SPARKS, ASHLEY N (FNP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:SPARKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1314
Mailing Address - Country:US
Mailing Address - Phone:317-560-4300
Mailing Address - Fax:317-530-9084
Practice Address - Street 1:821 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1314
Practice Address - Country:US
Practice Address - Phone:317-560-4300
Practice Address - Fax:317-530-9084
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004970A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01347741OtherMEDICARE RR PTAN
IN3249010OtherPTAN
IN201239050Medicaid