Healthcare Provider Details

I. General information

NPI: 1154574994
Provider Name (Legal Business Name): DARIAN EDWARD SPARKS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 2 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

OPC 2 BOX 60
APO AE
09094-9001
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone: 314-479-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: