Healthcare Provider Details

I. General information

NPI: 1740879329
Provider Name (Legal Business Name): ALEXIS DANIELLE SPARKS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 12/12/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PLAZA CT
PLATTE CITY MO
64079-7349
US

IV. Provider business mailing address

16795 NW 132ND TER
PLATTE CITY MO
64079-7346
US

V. Phone/Fax

Practice location:
  • Phone: 816-431-2150
  • Fax:
Mailing address:
  • Phone: 816-838-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021027722
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-140534-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: