Provider Demographics
NPI:1417154170
Name:SPROLES, CHRISTI M (APN)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:M
Last Name:SPROLES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13605 HANSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-5366
Mailing Address - Country:US
Mailing Address - Phone:501-379-8064
Mailing Address - Fax:
Practice Address - Street 1:800 MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3591
Practice Address - Country:US
Practice Address - Phone:501-364-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03011363LN0005X
LAAP04443363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622311Medicaid