MEDICARE: MADISON LYNN SPARKS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5667	OK

General Provider Information

NPI Number	:	1023836384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LYNN SPARKS PA-C

Provider Business Mailing Address
First Line	:	8900 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-8002
Country	:	US
Telephone Number	:	405-898-9972
Fax Number	:

Provider Business Practice Location Address
First Line	:	8900 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-8002
Country	:	US
Telephone Number	:	405-737-3278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	11/28/2025

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