Provider Demographics
NPI:1265410443
Name:SPRINKLE, WESLEY BRENT (DO)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:BRENT
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5202
Mailing Address - Country:US
Mailing Address - Phone:501-663-3647
Mailing Address - Fax:501-663-7931
Practice Address - Street 1:600 S MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5202
Practice Address - Country:US
Practice Address - Phone:501-663-3647
Practice Address - Fax:501-663-7931
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2728208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149750003Medicaid
AR5M527C207OtherPTAN
AR149750003Medicaid
ARH87063Medicare UPIN