Provider Demographics
NPI:1740879329
Name:SPARKS, ALEXIS DANIELLE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16795 NW 132ND TER
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7346
Mailing Address - Country:US
Mailing Address - Phone:816-838-1722
Mailing Address - Fax:
Practice Address - Street 1:1310 PLAZA CT
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7349
Practice Address - Country:US
Practice Address - Phone:816-431-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-140534-051163W00000X
MO2021027722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse