Provider Demographics
NPI:1689465221
Name:SPARKS, WAYNE RAY (RPSS)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:RAY
Last Name:SPARKS
Suffix:
Gender:M
Credentials:RPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8136
Mailing Address - Country:US
Mailing Address - Phone:214-664-7195
Mailing Address - Fax:
Practice Address - Street 1:5151 MAPLE AVE STE 4D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-8136
Practice Address - Country:US
Practice Address - Phone:469-419-1209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1729-0323175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist