Provider Demographics
NPI:1679101190
Name:ASPARKLE INCLUSIVE CARE
Entity Type:Organization
Organization Name:ASPARKLE INCLUSIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP- PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:HORTENSE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BISSILA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:901-800-1037
Mailing Address - Street 1:1750 LICHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3561
Mailing Address - Country:US
Mailing Address - Phone:901-800-1037
Mailing Address - Fax:
Practice Address - Street 1:8225 ROCKCREEK PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4594
Practice Address - Country:US
Practice Address - Phone:901-800-1037
Practice Address - Fax:877-669-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty