Healthcare Provider Details

I. General information

NPI: 1417833211
Provider Name (Legal Business Name): PAIGE ALEXIS SPARKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 REFUGEE RD
PICKERINGTON OH
43147-9653
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8883
  • Fax: 614-566-8149
Mailing address:
  • Phone: 614-544-6366
  • Fax: 614-544-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009730RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: