Theresa A Sparks, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9173 Issued in FL

Practice address

910 S 8TH St Ste 134
Fernandina Beach, FL 32034-6700

Phone

(904) 891-4565

Fax

(904) 212-1216

NPI assigned

Mar 15, 2006

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Theresa a. Sparks, PH.D., Inc.

  • Clinical Psychologist
  • Fernandina Beach, FL
  • NPI 1679955181
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1538138367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 EGRET LN",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344445",
            "telephone_number": "904-891-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 8TH ST STE 134",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320346700",
            "telephone_number": "904-891-4565",
            "fax_number": "904-212-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "THERESA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002794",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "699989780A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Felix Alexander Soleh, APRN, PMHNP-C
• Kenneth A Son, MD
• Janai Sookbir, M.S. CCC-SLP
• Michael Patrick Soos, D.O.
• Nicole Marie Soos, DO
• Speech Pathology Associates, P.a.
• Leomi Marie Spence, OTR/L
• Sinead Spratto, CCC-SLP
• Russell B Stapleton, MD
• Leanna Brooke Stebbins, APRN

• Clinical Psychologist in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.