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General NPI Number Information
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NPI Number | 1689465221
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Entity Type | Individual
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Provider Name | WAYNE RAY SPARKS RPSS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 5151 MAPLE AVE STE 4D
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City | DALLAS
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State | TX
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Zip | 75235-8136
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Country | US
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Telephone | 469-419-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 MAPLE AVE
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City | DALLAS
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State | TX
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Zip | 75235-8136
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Country | US
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Telephone | 214-664-7195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1729-0323
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License Number State | TX
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