Provider Demographics
NPI:1982343943
Name:SPARKS, NICHOLAS (DNP)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:SPARKS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SYCAMORE CT
Mailing Address - Street 2:STE 1B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1545
Mailing Address - Country:US
Mailing Address - Phone:812-378-9027
Mailing Address - Fax:812-378-1014
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5351
Practice Address - Country:US
Practice Address - Phone:800-841-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-29
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28230169A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered