Provider Demographics
NPI:1265472880
Name:SPROLES, AMY C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:SPROLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA130028364SE0003X
TXPA08812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01433269OtherRAIL ROAD MEDICARE
TX338953803Medicaid
TX338953805Medicaid
TX75-2616977-028OtherTRICARE
TX75-2616977-001OtherTRICARE
TX8985NMOtherBCBS
TX338953804Medicaid
TX75-0818167-015OtherTRICARE
TX75-0818167-048OtherTRICARE
TX75-1976930-005OtherTRICARE
TX75-0818167-022OtherTRICARE
TX75-0818167-044OtherTRICARE
TXP01429137OtherMEDICARE RAIL ROAD
TX8986NMOtherBCBS
TXP01429303OtherMEDICARE RAIL ROAD
TX338953806Medicaid
TX75-2616977-002OtherTRICARE
TX8987NMOtherBCBS
TXP01429303OtherRAIL ROAD MEDICARE
TX8984NMOtherBCBS
TX338953806Medicaid
TX385527YNSXMedicare PIN
TX385527YS6PMedicare PIN
TX385527YS6VMedicare PIN