Provider Demographics
NPI:1144826314
Name:SPARKS, MARY ELAINE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELAINE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3503 MEMORIAL PKWY NW STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-2445
Mailing Address - Country:US
Mailing Address - Phone:256-945-7190
Mailing Address - Fax:
Practice Address - Street 1:3503 MEMORIAL PKWY NW STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-2445
Practice Address - Country:US
Practice Address - Phone:256-945-7190
Practice Address - Fax:256-562-8700
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-145441363LA2100X
AL2020003093363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care