MEDICARE: MS. AMY C SPROLES P.A.-C

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SE0003X	Emergency Clinical Nurse Specialist	PA130028	OR
2	363A00000X	Physician Assistant	PA08812	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01433269	OTHER	TX	RAIL ROAD MEDICARE
13	P01429137	OTHER	TX	MEDICARE RAIL ROAD
15	P01429303	OTHER	TX	MEDICARE RAIL ROAD
19	P01429303	OTHER	TX	RAIL ROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	75-2616977-028	OTHER	TX	TRICARE
5	75-2616977-001	OTHER	TX	TRICARE
6	8985NM	OTHER	TX	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	75-0818167-015	OTHER	TX	TRICARE
9	75-0818167-048	OTHER	TX	TRICARE
10	75-1976930-005	OTHER	TX	TRICARE
11	75-0818167-022	OTHER	TX	TRICARE
12	75-0818167-044	OTHER	TX	TRICARE
14	8986NM	OTHER	TX	BCBS
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	75-2616977-002	OTHER	TX	TRICARE
18	8987NM	OTHER	TX	BCBS
20	8984NM	OTHER	TX	BCBS

NPI Number	:	1265472880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY C SPROLES P.A.-C

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-606-6400
Fax Number	:	903-606-1522

Provider Business Practice Location Address
First Line	:	800 E DAWSON ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2036
Country	:	US
Telephone Number	:	903-593-8441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/22/2026

3901 RAINBOW BLVD , PROFESSIONAL SERVICES OF KU HOSPITAL
KANSAS CITY, KS
66160-0001

Practice Phone: 913-588-6504
Practice Fax: 913-588-9104