Provider Demographics
NPI:1558946277
Name:SPARKS, AMITY BLYTHE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:AMITY
Middle Name:BLYTHE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RN, BSN
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 350
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-0350
Mailing Address - Country:US
Mailing Address - Phone:918-253-1761
Mailing Address - Fax:
Practice Address - Street 1:859 E MELTON DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2704
Practice Address - Country:US
Practice Address - Phone:918-253-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0094749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse