Active NPI
Deidre Sparks
- Physical Therapist
- Wynne, AR
National Provider Identifier
1013568393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4680
- Practice address
- 1871 Falls Blvd N
Wynne, AR 72396-4026 - Phone
- (870) 208-8989
- NPI assigned
- Sep 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4680 | AR | Primary |
Addresses
Primary practice location
1871 Falls Blvd N
Wynne, AR 72396-4026
Mailing address
10 Willow Creek LN Apt 10109
Jonesboro, AR 72404-7319
Phone (870) 494-0156
Other names 1
- Dr. Deidre Sparks
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4680 | AR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boaz & Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569456000000",
"number": "1013568393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WILLOW CREEK LN APT 10109",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724047319",
"telephone_number": "870-494-0156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1871 FALLS BLVD N",
"city": "WYNNE",
"state": "AR",
"postal_code": "723964026",
"telephone_number": "870-208-8989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPARKS",
"first_name": "DEIDRE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-26",
"last_updated": "2019-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "4680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DEIDRE",
"last_name": "SPARKS",
"prefix": "DR.",
"credential": "DPT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Wynne, AR
- Dalisha Lareece Smith, MHPP
- Kara Hardin Smith, PHARM.D
- Tonya Smith, QBHB
- Southern Care, Inc
- Southern Dental Group, PLLC
- Speech Works, LLC
- St Bernard Community Hospital Corporation
- St Bernard Community Hospital Corporation (CrossRidge Community Hospital)
- St Bernard Community Hospital Corporation
- St Bernard Community Hospital Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.