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NPI Code Detail

MEDICARE: DAVID T SPARKS CRNA

MEDICARE: DAVID T SPARKS CRNA
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
1367500000XCertified Registered Nurse Anesthetist096000MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699734350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID T SPARKS CRNA
Provider Business Mailing Address
First Line : 800 S ASH ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3224
Country : US
Telephone Number : 417-882-6744
Fax Number :
Provider Business Practice Location Address
First Line : 800 S ASH ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3223
Country : US
Telephone Number : 417-667-3355
Fax Number : 816-461-6586
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 11/21/2017

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