MEDICARE: SPARROW MENTAL HEALTH PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1861376477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARROW MENTAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	888 CASINO RD
Second Line	:
City	:	NOCONA
State	:	TX
Zip	:	76255-0940
Country	:	US
Telephone Number	:	817-301-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 KELL BLVD STE 302
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-1049
Country	:	US
Telephone Number	:	940-432-3444
Fax Number	:	940-432-5558

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	MRS. MIRANDA JUNE CLEMONS
Credential	:	PMHNP
Telephone Number	:	817-301-6277

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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