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General NPI Number Information
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NPI Number | 1700677358
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Entity Type | Organization
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Legal Business Name | SPARKS PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1500 NW BETHANY BLVD. SUITE 200
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City | BEAVERTON
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State | OR
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Zip | 97006
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Country | US
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Telephone | 503-782-5651
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Fax |
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Provider Business Mailing Address
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Address Line | 7698 SW 143RD ST
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City | PALMETTO BAY
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State | FL
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Zip | 33158-1638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JODY PAUWELS
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Credential |
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Telephone | 503-782-5651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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